Healthcare Provider Details

I. General information

NPI: 1053693242
Provider Name (Legal Business Name): VLADIMIR A VALERA ROMERO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DR 1-5940W
BETHESDA MD
20892-1107
US

IV. Provider business mailing address

10 CENTER DR 1-5940W
BETHESDA MD
20892-1107
US

V. Phone/Fax

Practice location:
  • Phone: 301-496-6353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number51575
License Number StateZZ
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberD0081617
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: