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General NPI Number Information
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NPI Number | 1417097163
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Entity Type | Individual
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Provider Name | RAQUEL DA SILVA GUEVARA FORGUES P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 06/18/2020
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Provider Practice Location Address
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Address Line | 3001 S HANOVER ST
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City | BALTIMORE
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State | MD
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Zip | 21225-1233
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Country | US
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Telephone | 410-350-3312
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Fax |
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Provider Business Mailing Address
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Address Line | 7428 OTTENBROOK TER
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City | DERWOOD
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State | MD
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Zip | 20855-1988
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Country | US
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Telephone | 301-915-4173
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | C0002585
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License Number State | MD
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