Provider Demographics
NPI:1104935238
Name:TRINIDAD VIDALOR, RHADAMES (MD)
Entity type:Individual
Prefix:MR
First Name:RHADAMES
Middle Name:
Last Name:TRINIDAD VIDALOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CONDOMINIO COSTA MARINA II
Mailing Address - Street 2:APARTAMENTO 3J
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983
Mailing Address - Country:US
Mailing Address - Phone:787-378-3130
Mailing Address - Fax:787-378-3130
Practice Address - Street 1:CARR 21 LAS LOMAS
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-782-8058
Practice Address - Fax:787-782-8058
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6178207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0061085OtherLA CRUZ AZUL DE PUERTO RI
27446OtherTRIPLE S
500043EOtherMEDICARE MUCHO MAS MMM
228011OtherPREFERRED HEALTH PLAN
2473OtherPREFERRED MEDICAL CHOICE
2473OtherPREFERRED MEDICAL CHOICE
27446Medicare ID - Type Unspecified