Individual
JORGE VALLECILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1319 LIGHT ST, BALTIMORE, MD 21230-4307
(410) 789-1084
(410) 636-2563
Mailing address
1319 LIGHT STREET, BALTIMORE, MD 21230
(410) 789-1084
(410) 636-2563
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D0026203
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208508900
—
MD
Enumeration date
09/06/2006
Last updated
08/21/2008
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