Basic Information
| Provider Information | |||||||||
| NPI: | 1073795613 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ECHEVERRI | ||||||||
| FirstName: | ROBERTO | ||||||||
| MiddleName: | JULIO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 E EAGER ST | ||||||||
| Address2: | FAMILY MEDICINE | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212025533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105028379 | ||||||||
| FaxNumber: | 4105225138 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 E EAGER ST | ||||||||
| Address2: | FAMILY MEDICINE | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212025533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105028379 | ||||||||
| FaxNumber: | 4105225138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2007 | ||||||||
| LastUpdateDate: | 04/29/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME102302 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | D0066596 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | P19554 | MD | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 414795200 | 05 | MD | MEDICAID |