Provider Demographics
NPI:1154337475
Name:NEGRO, PAULO JACOMO JR (MD)
Entity type:Individual
Prefix:DR
First Name:PAULO
Middle Name:JACOMO
Last Name:NEGRO
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:11801 SNOW PATCH WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4414
Mailing Address - Country:US
Mailing Address - Phone:410-262-5621
Mailing Address - Fax:410-730-2934
Practice Address - Street 1:11801 SNOW PATCH WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-4414
Practice Address - Country:US
Practice Address - Phone:410-262-5621
Practice Address - Fax:410-730-2934
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2020-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD00537362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402470200Medicaid
MDH705E652Medicare ID - Type Unspecified