Provider Demographics
NPI:1063547289
Name:SIATON, BERNADETTE CAVANEYRO (MD)
Entity type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:CAVANEYRO
Last Name:SIATON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-706-6474
Mailing Address - Fax:410-706-0231
Practice Address - Street 1:10 S PINE ST
Practice Address - Street 2:MSTF 8-34
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1116
Practice Address - Country:US
Practice Address - Phone:410-706-6474
Practice Address - Fax:410-706-0231
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0071999207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD332514800Medicaid
MD975052-01OtherCAREFIRST BC/BS
MDS062-0441OtherCAREFIRST BC/BS - REGIONAL
MD975052-01OtherCAREFIRST BC/BS
MDP0148763Medicare PIN