Provider Demographics
NPI:1144204785
Name:MALDONADO RAMIREZ, MARIO (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:MALDONADO RAMIREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:CALLE SAN MANUEL #5
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-0710
Mailing Address - Country:US
Mailing Address - Phone:787-859-0446
Mailing Address - Fax:787-859-3873
Practice Address - Street 1:5 CALLE SAN MANUEL
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-2086
Practice Address - Country:US
Practice Address - Phone:787-859-0446
Practice Address - Fax:787-859-3873
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2023-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7018207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C79718Medicare UPIN
PR28122MAMedicare ID - Type Unspecified