Provider Demographics
NPI:1376919639
Name:AREVALO, JOSE FERNANDO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:FERNANDO
Last Name:AREVALO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:600 N WOLFE ST
Mailing Address - Street 2:MAUMENEE 708
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0005
Mailing Address - Country:US
Mailing Address - Phone:443-287-9554
Mailing Address - Fax:443-287-5492
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:MAUMENEE 708
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:443-287-9554
Practice Address - Fax:443-287-5492
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2022-03-28
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Provider Licenses
StateLicense IDTaxonomies
MDD48407207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD48407OtherLICENSE