Provider Demographics
NPI:1851385603
Name:RIVERA, ERNESTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ERNESTO
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3501 SINCLAIR LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-2029
Mailing Address - Country:US
Mailing Address - Phone:410-732-8800
Mailing Address - Fax:410-534-2392
Practice Address - Street 1:3700 FLEET ST
Practice Address - Street 2:STE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4200
Practice Address - Country:US
Practice Address - Phone:410-558-4900
Practice Address - Fax:410-522-5070
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD18554207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD118131900Medicaid
W1050001OtherBLUE CHOICE
07124OtherAMERIGROUP
MD6774EOtherCAREFIRST BLUE SHIELD MD
21536OtherMDIPA
E50658Medicare UPIN
MD118131900Medicaid