Provider Demographics
NPI:1336108745
Name:MADRID, VICTOR B (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:B
Last Name:MADRID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VICTOR
Other - Middle Name:MADRID
Other - Last Name:BUENCONSEJO
Other - Suffix:III
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6501 BALTIMORE NATIONAL PIKE STE D
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3923
Mailing Address - Country:US
Mailing Address - Phone:667-234-2100
Mailing Address - Fax:667-234-2944
Practice Address - Street 1:6501 BALTIMORE NATIONAL PIKE STE D
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3923
Practice Address - Country:US
Practice Address - Phone:667-234-2100
Practice Address - Fax:667-234-2944
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407524200Medicaid
MD0003OtherCAREFIRST-DC
MD407524200Medicaid
G73017Medicare UPIN
MD539P104HMedicare PIN