Provider Demographics
NPI:1205937406
Name:ACLE, FERNANDO J (MD)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:J
Last Name:ACLE
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 1:26822 ROBERT BURNS LN
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-2357
Mailing Address - Country:US
Mailing Address - Phone:410-352-5527
Mailing Address - Fax:410-352-3024
Practice Address - Street 1:100 E. CARROLL STREET
Practice Address - Street 2:PRMC
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-352-5527
Practice Address - Fax:410-352-3024
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0041211207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD345100300Medicaid
MD003MMedicare ID - Type UnspecifiedMEDICARE PROV#