Provider Demographics
NPI:1285619619
Name:MARIN VIEIRA, RADAMES A (MD)
Entity type:Individual
Prefix:DR
First Name:RADAMES
Middle Name:A
Last Name:MARIN VIEIRA
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:PO BOX 807
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-0807
Mailing Address - Country:US
Mailing Address - Phone:787-364-0514
Mailing Address - Fax:
Practice Address - Street 1:FELIX TIO #35
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637
Practice Address - Country:US
Practice Address - Phone:787-873-5511
Practice Address - Fax:787-873-5511
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0088624Medicare ID - Type UnspecifiedPROVIDER NUMBER
PRG03020Medicare UPIN