Healthcare Provider Details

I. General information

NPI: 1164917654
Provider Name (Legal Business Name): NESTOR ENRIQUE VASQUEZ ENCINAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date: 02/13/2019
Reactivation Date: 04/10/2019

III. Provider practice location address

1800 ORLEANS ST
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

1800 ORLEANS ST
BALTIMORE MD
21287-0010
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberD0105684
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: