Organization
MIGUEL A HEREDIA, MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIGUEL ARQUIMEDES HEREDIA M.D. (MEDICAL DOCTOR)
(410) 788-6575
Entity
Organization
Contact information
Practice address
413 COMMONWEALTH AVE, BALTIMORE, MD 21228-3044
(410) 788-6575
(410) 744-1088
Mailing address
413 COMMONWEALTH AVE, BALTIMORE, MD 21228-3044
(410) 788-6575
(410) 744-1088
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
D0004971
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
068121100
—
MD
Enumeration date
04/28/2010
Last updated
04/28/2010
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