Provider Demographics
NPI:1740471861
Name:MONROY TRUJILLO, JOSE M (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:MONROY TRUJILLO
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 1:503 BYRN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1917
Mailing Address - Country:US
Mailing Address - Phone:410-221-7770
Mailing Address - Fax:410-221-7863
Practice Address - Street 1:503 BYRN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1917
Practice Address - Country:US
Practice Address - Phone:410-221-7770
Practice Address - Fax:410-221-7863
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0073394207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD447103200Medicaid
MDE6360019OtherBS FEDERAL
MDP20146OtherBS POINT OF SERVICE
MD97696702OtherBS
MD447103200Medicaid