Healthcare Provider Details

I. General information

NPI: 1750376406
Provider Name (Legal Business Name): MARCO ANTONIO CORCHADO BARRETO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7260 AVE AGUSTIN RAMOS CALERO
ISABELA PR
00662-3592
US

IV. Provider business mailing address

PO BOX 1039
ISABELA PR
00662-1039
US

V. Phone/Fax

Practice location:
  • Phone: 787-872-8313
  • Fax: 787-872-8313
Mailing address:
  • Phone: 787-872-8313
  • Fax: 787-872-8313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number12847
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: