Provider Demographics
NPI:1548207038
Name:HIDALGO, GUILLERMO (MD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:
Last Name:HIDALGO
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 1:3600 ROUTE 66 FL 3
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2605
Mailing Address - Country:US
Mailing Address - Phone:732-807-0877
Mailing Address - Fax:201-751-1680
Practice Address - Street 1:19 DAVIS AVE FL 5
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4488
Practice Address - Country:US
Practice Address - Phone:732-897-3400
Practice Address - Fax:732-897-3481
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084948208000000X
IL0361171552080P0210X
NC2011-001272080P0210X
NJ25MA106792002080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5916951Medicaid
NC161WYOtherBCBSNC
IL036117155OtherMEDICAL LICENSE
NC161WYOtherBCBSNC
NC5916951Medicaid