Healthcare Provider Details

I. General information

NPI: 1699758185
Provider Name (Legal Business Name): ERNESTO C TORRES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 THOMAS JOHNSON DR SUITE 202
FREDERICK MD
21702-4505
US

IV. Provider business mailing address

188 THOMAS JOHNSON DR SUITE 202
FREDERICK MD
21702-4505
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-2252
  • Fax: 301-663-8740
Mailing address:
  • Phone: 301-662-2252
  • Fax: 301-663-8740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD23651
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: