Healthcare Provider Details

I. General information

NPI: 1053567313
Provider Name (Legal Business Name): CLAUDIA GLORIA LARES ROMERO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 12/08/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 MEDICAL CENTER DR
ROCKVILLE MD
20850-3357
US

IV. Provider business mailing address

9901 MEDICAL CENTER DR
ROCKVILLE MD
20850-3357
US

V. Phone/Fax

Practice location:
  • Phone: 240-826-7550
  • Fax:
Mailing address:
  • Phone: 240-826-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.121639
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number24583
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberD0092646
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: