Healthcare Provider Details

I. General information

NPI: 1316910011
Provider Name (Legal Business Name): JORGE C. SECADA-LOVIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2006
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 KENILWORTH DR STE 214
TOWSON MD
21204-2143
US

IV. Provider business mailing address

1122 KENILWORTH DR STE 214
TOWSON MD
21204-2143
US

V. Phone/Fax

Practice location:
  • Phone: 410-321-9701
  • Fax: 410-321-0845
Mailing address:
  • Phone: 410-321-9701
  • Fax: 410-321-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD22633
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier42068810
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerCAREFIRST
# 2
IdentifierP00611137
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerRAILROAD MEDICARE
# 3
IdentifierJ046 0001
Identifier TypeOTHER
Identifier StateDC
Identifier IssuerCAREFIRST
# 4
Identifier477541400
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: