Provider Demographics
NPI:1497595490
Name:VERA RICAURTE, MICHAEL DE JESUS (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DE JESUS
Last Name:VERA RICAURTE
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:ALBERT EINSTEIN MEDICAL CENTER, 5501 OLD YORK ROAD,
Mailing Address - Street 2:PHILA., PA 19141
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141
Mailing Address - Country:US
Mailing Address - Phone:215-456-6500
Mailing Address - Fax:
Practice Address - Street 1:ALBERT EINSTEIN MEDICAL CENTER, 5501 OLD YORK ROAD,
Practice Address - Street 2:PHILA., PA 19141
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141
Practice Address - Country:US
Practice Address - Phone:215-456-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program