Provider Demographics
NPI:1952152746
Name:AQUINO COLON, ANDRES R (MD)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:R
Last Name:AQUINO COLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANDRES
Other - Middle Name:R
Other - Last Name:AQUINO COLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ANDRES R AQUINO
Mailing Address - Street 1:2528 LISA DR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3368
Mailing Address - Country:US
Mailing Address - Phone:917-615-3025
Mailing Address - Fax:
Practice Address - Street 1:8701 WATERTOWN PLANK RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3548
Practice Address - Country:US
Practice Address - Phone:917-615-3025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIPAR-00003529972085R0204X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology