Healthcare Provider Details

I. General information

NPI: 1760423313
Provider Name (Legal Business Name): MIGUEL ANTONIO FRONTERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 FAIRMOUNT AVE SUITE 640
TOWSON MD
21286-5466
US

IV. Provider business mailing address

515 FAIRMOUNT AVE CREDENTIALING DEPARTMENT
TOWSON MD
21286-5466
US

V. Phone/Fax

Practice location:
  • Phone: 410-494-1350
  • Fax: 410-494-1374
Mailing address:
  • Phone: 410-494-1324
  • Fax: 410-494-1361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD37559
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: