=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306817341
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARCELINO DANIEL ALBUERNE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2006
-----------------------------------------------------
Last Update Date | 08/06/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 516 N ROLLING RD SUITE 106
-----------------------------------------------------
City | CATONSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21228-4140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-744-4044
-----------------------------------------------------
Fax | 410-744-7923
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10309 WETHERBURN RD
-----------------------------------------------------
City | ELLICOTT CITY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21042-1687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-465-6882
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | D0029769
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------