Provider Demographics
NPI:1790736155
Name:RIVERO, GUSTAVO ADOLFO (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:ADOLFO
Last Name:RIVERO
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 1:500 FRANK W BURR BOULEVARD
Mailing Address - Street 2:SUITE 560 MAILBOX 29
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666
Mailing Address - Country:US
Mailing Address - Phone:201-510-0910
Mailing Address - Fax:201-621-6931
Practice Address - Street 1:3800 RESERVOIR RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-3736
Practice Address - Fax:202-444-0939
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3066207R00000X, 207RH0000X
FLME 93827207R00000X
DCMD210003079207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29467OtherBCBS
FL2741245-00Medicaid
FL100127C041273OtherMCARE 1011
DC023680306Medicaid
DC2Q5020OtherMEDICARE
FLP00384348OtherRR MCARE