Provider Demographics
NPI:1346344835
Name:REYES DOLLETE, FE TAVERNERO (MD)
Entity Type:Individual
Prefix:DR
First Name:FE
Middle Name:TAVERNERO
Last Name:REYES DOLLETE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:8813 WALTHAM WOODS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234
Mailing Address - Country:US
Mailing Address - Phone:410-661-5330
Mailing Address - Fax:410-661-4107
Practice Address - Street 1:8813 WALTHAM WOODS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234
Practice Address - Country:US
Practice Address - Phone:410-661-5330
Practice Address - Fax:410-661-4102
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MDD15809208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
B70814Medicare UPIN