Healthcare Provider Details

I. General information

NPI: 1811214703
Provider Name (Legal Business Name): CHARINA CECILLE REYES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2010
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7556 TEAGUE RD SUITE 420
HANOVER MD
21076-1213
US

IV. Provider business mailing address

PO BOX 62063
BALTIMORE MD
21264-2063
US

V. Phone/Fax

Practice location:
  • Phone: 443-755-0681
  • Fax: 443-755-0685
Mailing address:
  • Phone: 410-706-5181
  • Fax: 410-706-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD82205
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberD82205
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: