Provider Demographics
NPI:1316910011
Name:SECADA-LOVIO, JORGE C (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:C
Last Name:SECADA-LOVIO
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 1:1122 KENILWORTH DR STE 214
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2143
Mailing Address - Country:US
Mailing Address - Phone:410-321-9701
Mailing Address - Fax:410-321-0845
Practice Address - Street 1:1122 KENILWORTH DR STE 214
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2143
Practice Address - Country:US
Practice Address - Phone:410-321-9701
Practice Address - Fax:410-321-0845
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-12
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD22633207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD42068810OtherCAREFIRST
GAP00611137OtherRAILROAD MEDICARE
DCJ046 0001OtherCAREFIRST
MD477541400Medicaid
MD496P958GMedicare PIN
DCJ046 0001OtherCAREFIRST