Provider Demographics
NPI:1760415293
Name:FUENTES, GLORIA (MD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:
Last Name:FUENTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6320
Mailing Address - Country:US
Mailing Address - Phone:410-602-9842
Mailing Address - Fax:410-602-9857
Practice Address - Street 1:4 W ROLLING CROSSROADS
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-6280
Practice Address - Country:US
Practice Address - Phone:410-869-0100
Practice Address - Fax:410-869-0460
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033157208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
0028OtherCAREFIRST DC
2328095OtherAETNA HMO
MD012335OtherJOHNS HOPKINS HEALTHCARE
35168804OtherCAREFIRST MARYLAND
700904OtherNCPPO
7090097OtherAETNA PPO
281932OtherMAMSI
9974OtherKAISER
MD1203593Medicaid
MD435681100Medicaid
110155OtherCOVENTRY
1981791OtherUNITED HEALTHCARE
MD93130Medicaid
6763604OtherCIGNA
7090097OtherAETNA PPO
2328095OtherAETNA HMO
MD435681100Medicaid