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Individual

RAYNOLD DEPESTRE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3704 LANAMER RD, RANDALLSTOWN, MD 21133-1517
(410) 265-5400
(410) 298-3917
Mailing address
3704 LANAMER RD, RANDALLSTOWN, MD 21133
(410) 655-4946

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D27157
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
484691500
MD
Enumeration date
09/05/2006
Last updated
04/15/2019
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