Healthcare Provider Details

I. General information

NPI: 1033145321
Provider Name (Legal Business Name): ALIDA MERCEDES ESPINOZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: ALIDA MERCEDES ANDRIOLLO-ESPINOZA MD

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 OPAL CT
HAGERSTOWN MD
21740-5940
US

IV. Provider business mailing address

6928 SANDY CREEK CT
CLARKSVILLE MD
21029-1747
US

V. Phone/Fax

Practice location:
  • Phone: 301-797-8279
  • Fax: 301-797-8504
Mailing address:
  • Phone: 443-535-8699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberD0062607
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: