Healthcare Provider Details

I. General information

NPI: 1003112210
Provider Name (Legal Business Name): INES MARIA VIGIL MD, MPH, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2011
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 CURTIS CT
GLEN BURNIE MD
21060-6405
US

IV. Provider business mailing address

6701 CURTIS CT
GLEN BURNIE MD
21060-6405
US

V. Phone/Fax

Practice location:
  • Phone: 443-845-2816
  • Fax:
Mailing address:
  • Phone: 443-845-2816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberD0068184
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number4301093338
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: