Healthcare Provider Details

I. General information

NPI: 1235938838
Provider Name (Legal Business Name): MR. KARL NAVARRO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15408 GOVERNORS PARK LN
UPPER MARLBORO MD
20772-8283
US

IV. Provider business mailing address

15408 GOVERNORS PARK LN
UPPER MARLBORO MD
20772-8283
US

V. Phone/Fax

Practice location:
  • Phone: 757-761-1208
  • Fax:
Mailing address:
  • Phone: 757-761-1208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR241652
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: