Provider Demographics
NPI:1699844092
Name:MERINO-JUAREZ, JOSE GUILLERMO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:GUILLERMO
Last Name:MERINO-JUAREZ
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 64526
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 S EUTAW ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1606
Practice Address - Country:US
Practice Address - Phone:410-328-4323
Practice Address - Fax:410-328-1149
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0347262084N0400X
MDD00613952084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC39382500Medicaid
MD415096100Medicaid
DC39382500Medicaid