Provider Demographics
NPI:1306817341
Name:ALBUERNE, MARCELINO DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:MARCELINO
Middle Name:DANIEL
Last Name:ALBUERNE
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 1:10309 WETHERBURN RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1687
Mailing Address - Country:US
Mailing Address - Phone:410-465-6882
Mailing Address - Fax:
Practice Address - Street 1:516 N ROLLING RD
Practice Address - Street 2:SUITE 106
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4140
Practice Address - Country:US
Practice Address - Phone:410-744-4044
Practice Address - Fax:410-744-7923
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0029769207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD342001900OtherMEDICAL ASSISTANCE
DCR704 0001OtherCAREFIRST
GAP00830020OtherRAILROAD MEDICARE
MD41014402 (RENDERING)OtherCAREFIRST
MD587P212HOtherMEDICARE
MD41014402 (RENDERING)OtherCAREFIRST