Healthcare Provider Details

I. General information

NPI: 1518917293
Provider Name (Legal Business Name): MELANIE PEREZ MAGPANTAY-GARCIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1232 RACE RD SUITE 303
BALTIMORE MD
21237-2351
US

IV. Provider business mailing address

PO BOX 70011
BALTIMORE MD
21237-6011
US

V. Phone/Fax

Practice location:
  • Phone: 410-687-0808
  • Fax: 410-687-0070
Mailing address:
  • Phone: 410-687-0808
  • Fax: 410-687-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0051517
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: