Provider Demographics
NPI:1750376406
Name:CORCHADO BARRETO, MARCO ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:MARCO
Middle Name:ANTONIO
Last Name:CORCHADO BARRETO
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 1039
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-1039
Mailing Address - Country:US
Mailing Address - Phone:787-872-8313
Mailing Address - Fax:787-872-8313
Practice Address - Street 1:7260 AVE AGUSTIN RAMOS CALERO
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-3592
Practice Address - Country:US
Practice Address - Phone:787-872-8313
Practice Address - Fax:787-872-8313
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12847207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR100100WOtherMMM HEALTHCARE, INC
PR6620108OtherHUMANA HEALTH PLANS OF PR
PR20792COOtherTRIPLE S, INC.
PRPE-4617OtherPANAMERICAN LIFE INS COMP
PR115-12847OtherGLOBAL HEALTH PLAN
PR200332OtherPREFERRED HEALTH
PR9003753OtherLA CRUZ AZUL DE PR
PR9003753OtherLA CRUZ AZUL DE PR
PRH67641Medicare UPIN