Healthcare Provider Details

I. General information

NPI: 1861913147
Provider Name (Legal Business Name): LUIS ERNESTO CERNA URRUTIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 GREENSPRING AVE STE 304
BALTIMORE MD
21209-4358
US

IV. Provider business mailing address

5051 GREENSPRING AVE STE 304
BALTIMORE MD
21209-4358
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-7790
  • Fax:
Mailing address:
  • Phone: 410-601-7790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0102130
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: