Healthcare Provider Details

I. General information

NPI: 1689256620
Provider Name (Legal Business Name): FERNANDO REACHY GUADARRAMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 CAMBRIDGE MARKETPLACE BLVD
CAMBRIDGE MD
21613-2567
US

IV. Provider business mailing address

1931 SILVER LAKE LN
TRAPPE MD
21673-1687
US

V. Phone/Fax

Practice location:
  • Phone: 443-225-7500
  • Fax:
Mailing address:
  • Phone: 954-529-8249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0105336
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: