Provider Demographics
NPI:1841455763
Name:CERDAN TREVINO, MARIO ALBERTO (MD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:ALBERTO
Last Name:CERDAN TREVINO
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 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-2704
Mailing Address - Fax:
Practice Address - Street 1:4770 N EXPRESSWAY 77/83 STE 204
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3107
Practice Address - Country:US
Practice Address - Phone:956-452-1882
Practice Address - Fax:956-435-9133
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10032774390200000X
TXQ49142084N0400X
MDD994862084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program