Healthcare Provider Details

I. General information

NPI: 1215228036
Provider Name (Legal Business Name): RAMIRO SERGIO MALDONADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DUKE UNIVERSITY MEDICAL CTR OPHTHALMOLOGY DEPARTMENT
DURHAM NC
27710-0001
US

IV. Provider business mailing address

5213 S ALSTON AVE
DURHAM NC
27713-4430
US

V. Phone/Fax

Practice location:
  • Phone: 919-681-3816
  • Fax: 919-681-8856
Mailing address:
  • Phone: 919-620-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD457242
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2022-00189
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number51521
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: