Healthcare Provider Details

I. General information

NPI: 1306817341
Provider Name (Legal Business Name): MARCELINO DANIEL ALBUERNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 N ROLLING RD SUITE 106
CATONSVILLE MD
21228-4140
US

IV. Provider business mailing address

10309 WETHERBURN RD
ELLICOTT CITY MD
21042-1687
US

V. Phone/Fax

Practice location:
  • Phone: 410-744-4044
  • Fax: 410-744-7923
Mailing address:
  • Phone: 410-465-6882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberD0029769
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: