Provider Demographics
NPI:1770535320
Name:CORRECES, JERRY LOYOLA (MD)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:LOYOLA
Last Name:CORRECES
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 1:11110 MEDICAL CAMPUS RD
Mailing Address - Street 2:SUITE 229
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6700
Mailing Address - Country:US
Mailing Address - Phone:301-665-4549
Mailing Address - Fax:301-714-4293
Practice Address - Street 1:11110 MEDICAL CAMPUS RD
Practice Address - Street 2:SUITE 150
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6700
Practice Address - Country:US
Practice Address - Phone:301-665-4825
Practice Address - Fax:301-665-4826
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0041131207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD521831657OtherUS HEALTHCARE
MD525876-02OtherCAREFIRST BC/BS
MD1020111784OtherCIGNA
MD817926 OC1OtherOPTIMUM CHOICE
MD763511700Medicaid
MD817926MD2OtherMDIPA
MD52-1831657OtherALLIANCE
MDT361001OtherBLUE CHOICE
MD0004314173OtherAETNA
MD763511700Medicaid
MD0004314173OtherAETNA