Provider Demographics
NPI:1740224245
Name:CORDERO, JUAN (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:CORDERO
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 1:2001 MEDICAL PKWY
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-8943
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 DUTCHMANS LN STE A3
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-4302
Practice Address - Country:US
Practice Address - Phone:410-822-2440
Practice Address - Fax:410-822-2441
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD57950207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD986800300Medicaid
MDAT540006OtherBCBS
MD519644YBL9Medicare PIN
MDP01773390Medicare PIN
MD518182Y5ZMedicare PIN
MDAT540006OtherBCBS
MD978LMedicare ID - Type UnspecifiedMEDICARE
MD112941OtherCOVENTRY
MDW1610003OtherCAREFIRST BLUECHOICE
MDH47889Medicare UPIN