=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699758185
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERNESTO C TORRES M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 188 THOMAS JOHNSON DR SUITE 202
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21702-4505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-662-2252
-----------------------------------------------------
Fax | 301-663-8740
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 188 THOMAS JOHNSON DR SUITE 202
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21702-4505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-662-2252
-----------------------------------------------------
Fax | 301-663-8740
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | D23651
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------