Healthcare Provider Details

I. General information

NPI: 1538165964
Provider Name (Legal Business Name): EDUARDO DEL ROSARIO ESPIRIDION M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13114 PENNSYLVANIA AVE
HAGERSTOWN MD
21742-2741
US

IV. Provider business mailing address

11015 SANI LN
HAGERSTOWN MD
21742-4034
US

V. Phone/Fax

Practice location:
  • Phone: 240-520-8287
  • Fax: 240-566-3018
Mailing address:
  • Phone: 301-797-4069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD066842L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: