Provider Demographics
NPI:1184667743
Name:ACEVEDO-VILA, JORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:ACEVEDO-VILA
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 1:539 DAVID DR
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6186
Mailing Address - Country:US
Mailing Address - Phone:410-879-7035
Mailing Address - Fax:
Practice Address - Street 1:104 PLUMTREE RD
Practice Address - Street 2:SUITE 115
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6095
Practice Address - Country:US
Practice Address - Phone:410-515-4300
Practice Address - Fax:410-515-4318
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0034095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE112606OtherCOVENTRY
MD196721500Medicaid
MD2331054OtherAETNA HMO
MD5267094OtherAETNA PPO
12466OtherKAISER PERMANENTE
1978559OtherUNITED HEALTHCARE
MD52448201OtherCAREFIRST BCBS-MARYLAND
MD9418904001OtherCIGNA
MD035620OtherJOHNS HOPKINS HEALTHCARE
0403478OtherUHC-AMERICHOICE
MD3179-0025OtherCAREFIRST BCBS-DC
MD93100OtherAMERIGROUP
110102467OtherMEDICARE RAILROAD
281924OtherMAMSI HEALTH PLAN
MD196721500Medicaid
1978559OtherUNITED HEALTHCARE