Individual
DR. RAY GERVACIO FUENTES BLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6569 N CHARLES ST, STE 401, BALTIMORE, MD 21204-6831
(443) 849-8940
Mailing address
PO BOX 418953, BOSTON, MA 02241-8953
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
D64365
MD
2086X0206X
Surgical Oncology Physician
Primary
D64365
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
411454000
—
MD
01
—
KG72GB/89135601
CAREFIRST MARYLAND
MD
01
—
S1430006
CAREFIRST REGIONAL
MD
Enumeration date
01/09/2006
Last updated
12/23/2011
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