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1790736155

NPI Code Detail

MEDICARE: DR. GUSTAVO ADOLFO RIVERO M.D.

MEDICARE: DR. GUSTAVO ADOLFO RIVERO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	P3066	TX
2	207R00000X	Internal Medicine Physician	ME 93827	FL
3	207RH0000X	Hematology (Internal Medicine) Physician	P3066	TX
4	207RH0003X	Hematology & Oncology Physician	P3066	TX
5	207RH0000X	Hematology (Internal Medicine) Physician	MD210003079	DC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2Q5020	OTHER	DC	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	100127C041273	OTHER	FL	MCARE 1011
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	29467	OTHER	FL	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	P00384348	OTHER	FL	RR MCARE

General Provider Information

NPI Number	:	1790736155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUSTAVO ADOLFO RIVERO M.D.

Provider Business Mailing Address
First Line	:	500 FRANK W BURR BOULEVARD
Second Line	:	SUITE 560 MAILBOX 29
City	:	TEANECK
State	:	NJ
Zip	:	07666
Country	:	US
Telephone Number	:	201-510-0910
Fax Number	:	201-621-6931

Provider Business Practice Location Address
First Line	:	3800 RESERVOIR RD NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20007-2113
Country	:	US
Telephone Number	:	202-444-3736
Fax Number	:	202-444-0939

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	09/16/2024

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Directions to “ DR. GUSTAVO ADOLFO RIVERO M.D.” Practice Location

Language	Start Address	Practice Location

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