Provider Demographics
NPI:1710955133
Name:MADRINAN, REYNALDO P (MD)
Entity Type:Individual
Prefix:DR
First Name:REYNALDO
Middle Name:P
Last Name:MADRINAN
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 1:25 CROSSROADS DR
Mailing Address - Street 2:STE 306
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 MALCOLM DR
Practice Address - Street 2:SUITE A
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6160
Practice Address - Country:US
Practice Address - Phone:410-876-1633
Practice Address - Fax:410-840-2100
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0008306208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD77591600Medicaid
MD77591600Medicaid
MD731LO948Medicare PIN
MD698BMedicare ID - Type UnspecifiedINDIVIDUAL ID