Provider Demographics
NPI:1912963547
Name:REYES-SOTO, MARIA MAGDALENA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:MAGDALENA
Last Name:REYES-SOTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:M
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7521 BRAEMAR CT
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784
Mailing Address - Country:US
Mailing Address - Phone:443-223-1398
Mailing Address - Fax:
Practice Address - Street 1:6655 SYKESVILLE ROAD
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784
Practice Address - Country:US
Practice Address - Phone:410-970-7000
Practice Address - Fax:410-970-7324
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD40257208D00000X
PR8014208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
F22558Medicare UPIN
K743BM37Medicare ID - Type Unspecified