Provider Demographics
NPI:1598123754
Name:RAYMUNDO, MARIA MARTHA CARRILLO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA MARTHA
Middle Name:CARRILLO
Last Name:RAYMUNDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:RAYMUNDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6701 N CHARLES ST
Mailing Address - Street 2:SUITE 4202
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6808
Mailing Address - Country:US
Mailing Address - Phone:410-821-8444
Mailing Address - Fax:410-821-8447
Practice Address - Street 1:6701 N CHARLES ST
Practice Address - Street 2:SUITE 4202
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6808
Practice Address - Country:US
Practice Address - Phone:410-821-8444
Practice Address - Fax:410-821-8447
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054518207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine