Provider Demographics
NPI:1417097163
Name:GUEVARA FORGUES, RAQUEL DA SILVA (PA-C)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:DA SILVA
Last Name:GUEVARA FORGUES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:DA SILVA
Other - Last Name:GUEVARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7428 OTTENBROOK TER
Mailing Address - Street 2:
Mailing Address - City:DERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1988
Mailing Address - Country:US
Mailing Address - Phone:301-915-4173
Mailing Address - Fax:
Practice Address - Street 1:3001 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-1233
Practice Address - Country:US
Practice Address - Phone:410-350-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002585363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical