Provider Demographics
NPI:1851393565
Name:ARRISUENO, JUAN A (MD, PA)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:A
Last Name:ARRISUENO
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12502 WILLOWBROOK ROAD
Mailing Address - Street 2:SUITE 670
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1876
Mailing Address - Country:US
Mailing Address - Phone:301-777-5338
Mailing Address - Fax:301-777-8031
Practice Address - Street 1:12502 WILLOWBROOK RD
Practice Address - Street 2:670
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1873
Practice Address - Country:US
Practice Address - Phone:301-777-5338
Practice Address - Fax:301-777-8031
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDB40807208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD342981400Medicaid
MD342981400Medicaid
MDD23167Medicare UPIN