Provider Demographics
NPI:1972873792
Name:MALDONADO CORCHADO, ENRIQUE RAUL (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:RAUL
Last Name:MALDONADO CORCHADO
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:PO BOX 3972
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-3972
Mailing Address - Country:US
Mailing Address - Phone:787-708-6200
Mailing Address - Fax:
Practice Address - Street 1:136 CALLE CARAZO STE 3
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-6412
Practice Address - Country:US
Practice Address - Phone:787-708-6200
Practice Address - Fax:787-708-6228
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA258254207R00000X
NY390200000X
TXQ8103207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program