Organization
MODESTO S RIVERA III MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MODESTO SANTOS RIVERA III M.D. (PRESIDENT)
(410) 535-4242
Entity
Organization
Contact information
Practice address
806 SOLOMONS ISLAND RD N, PRNC FREDERCK, MD 20678-3919
(410) 535-3424
(410) 535-4983
Mailing address
806 SOLOMONS ISLAND RD N, PRNC FREDERCK, MD 20678-3919
(410) 535-3424
(410) 535-4983
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
D19963
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0283
GHMSI
—
05
—
1887319 00
—
MD
01
—
2122218
MAMSI
—
01
—
34888001
BLUE SHIELD CAREFIRST
MD
Enumeration date
04/28/2010
Last updated
04/28/2010
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