Provider Demographics
NPI:1689612103
Name:ARAUJO-VIDAL, FREDDY ORLANDO (MD)
Entity Type:Individual
Prefix:
First Name:FREDDY
Middle Name:ORLANDO
Last Name:ARAUJO-VIDAL
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 477
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-0477
Mailing Address - Country:US
Mailing Address - Phone:410-778-1420
Mailing Address - Fax:410-778-7086
Practice Address - Street 1:100 BROWN ST
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1435
Practice Address - Country:US
Practice Address - Phone:410-778-1420
Practice Address - Fax:410-778-7086
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045628174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD315641900Medicaid
MD315641900Medicaid
MD326L728BMedicare ID - Type Unspecified