Provider Demographics
NPI:1881681195
Name:DEANDINO, RICHARD M (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:DEANDINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6 CALLE MAR CARIBE
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-6356
Mailing Address - Country:US
Mailing Address - Phone:787-726-3901
Mailing Address - Fax:778-726-8583
Practice Address - Street 1:1025 CALLE MARGINAL VILLAMAR
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-6348
Practice Address - Country:US
Practice Address - Phone:787-726-3901
Practice Address - Fax:787-268-5838
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR5707207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR27065Medicare ID - Type Unspecified
PRE33094Medicare UPIN