Provider Demographics
NPI:1508937707
Name:MALDONADO, JOSEPH MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MANUEL
Last Name:MALDONADO
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:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-0454
Mailing Address - Country:US
Mailing Address - Phone:787-817-0763
Mailing Address - Fax:787-879-8671
Practice Address - Street 1:158 CALLE DELFIN OLMO
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4672
Practice Address - Country:US
Practice Address - Phone:787-817-0763
Practice Address - Fax:787-879-8671
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12055207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88615Medicare ID - Type Unspecified