Blanco, Ray Gervacio Fuentes
Blanco, Ray Gervacio Fuentes is an individual health care provider with primary practice located at 6569 N Charles St Ste 401, Baltimore MD 21204-6831. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Surgical Oncology. Allopathic & Osteopathic Physicians / Surgical Oncology is his primary health care specialty. Blanco, Ray Gervacio Fuentes can be contacted via phone (443) 849-8940.Contact Information
Primary practice address
6569 N Charles St Ste 401
Baltimore MD 21204-6831
Phone: (443) 849-8940
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | D64365 | Maryland |
| Allopathic & Osteopathic Physicians / Surgical Oncology | 2086X0206X | D64365 | Maryland |
Profile Details
| NPI number | 1891773966 |
|---|---|
| LBN Legal business name | Blanco, Ray Gervacio Fuentes |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 9th, 2006 |
| Last updated | Dec 23rd, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1891773966 | NPPES |
| Maryland | Other | KG72GB/89135601 | CAREFIRST MARYLAND |
| Maryland | MEDICAID | 411454000 | CAREFIRST MARYLAND |
| Maryland | Other | S1430006 | CAREFIRST MARYLAND |
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