Basic Information
| Provider Information | |||||||||
| NPI: | 1447408851 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VASQUEZ MARTINEZ | ||||||||
| FirstName: | NATALIA | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VASQUEZ | ||||||||
| OtherFirstName: | NATALIA | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 418953 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022418953 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6565 N CHARLES ST | ||||||||
| Address2: | STE 203 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212046800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438493760 | ||||||||
| FaxNumber: | 4438498138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2008 | ||||||||
| LastUpdateDate: | 07/31/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D071517 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | D71517 | MD | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 560031600 | 05 | MD | MEDICAID |