Healthcare Provider Details

I. General information

NPI: 1699735506
Provider Name (Legal Business Name): SALVADOR RODRIGO GUERRERO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 CHERRY LANE
LAUREL MD
20708
US

IV. Provider business mailing address

4948 BRAMPTON PKWY
ELLICOTT CITY MD
21043-7404
US

V. Phone/Fax

Practice location:
  • Phone: 301-497-1590
  • Fax:
Mailing address:
  • Phone: 570-618-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number232022
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number232022
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberOS13639
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS13639
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0084977
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: