| Modesto S Rivera Iii Md Pa | |
|
806 Solomons Island Rd N Prnc Frederck MD 20678-3919 | |
| (410) 535-3424 | |
| (410) 535-4983 |
| Full Name | Modesto S Rivera Iii Md Pa |
|---|---|
| Speciality | Clinic/center |
| Location | 806 Solomons Island Rd N, Prnc Frederck, Maryland |
| Authorized Official Name and Position | Modesto Santos Rivera (PRESIDENT) |
| Authorized Official Contact | 4105354242 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Modesto S Rivera Iii Md Pa 806 Solomons Island Rd N Prnc Frederck MD 20678-3919 Ph: (410) 535-3424 | Modesto S Rivera Iii Md Pa 806 Solomons Island Rd N Prnc Frederck MD 20678-3919 Ph: (410) 535-3424 |
| NPI Number | 1922325026 |
|---|---|
| Provider Enumeration Date | 04/28/2010 |
| Last Update Date | 04/28/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922325026 | NPI | - | NPPES |
| 0283 | Other | GHMSI | |
| 2122218 | Other | MAMSI | |
| 1887319 00 | Medicaid | MD | |
| 34888001 | Other | MD | BLUE SHIELD CAREFIRST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | D19963 (Maryland) | Primary |