Provider Demographics
NPI:1316155377
Name:MARCELINO D. ALBUERNE, M.D. P.A.
Entity type:Organization
Organization Name:MARCELINO D. ALBUERNE, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BEREZNAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-744-4044
Mailing Address - Street 1:516 N ROLLING RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4140
Mailing Address - Country:US
Mailing Address - Phone:410-744-4044
Mailing Address - Fax:410-744-7923
Practice Address - Street 1:516 N ROLLING RD
Practice Address - Street 2:SUITE 106
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4140
Practice Address - Country:US
Practice Address - Phone:410-744-4044
Practice Address - Fax:410-744-7923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD29769207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD342001900OtherMEDICAL ASSISTANCE (SOLO # LINKED TO NPI 2)
GADQ3021 (GROUP)OtherRAILROAD MEDICARE
DCR704 (GROUP)OtherCAREFIRST
MD587P (GROUP)OtherMEDICARE
MD1157MD (GROUP)OtherCAREFIRST