Active NPI
Protacio Azarcon Reyes, MD
- Pediatrics Physician
- Montgomry Village, MD
National Provider Identifier
1376538751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- D0004875
- Practice address
- 19261 Montgomery Village Ave
Ste G-13
Montgomry Village, MD 20886-5026 - Phone
- (301) 977-4100
- Fax
- (301) 977-4101
- NPI assigned
- Sep 13, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | D0004875 | MD | Primary |
Addresses
Primary practice location
19261 Montgomery Village Ave
Ste G-13
Montgomry Village, MD 20886-5026
Mailing address
19261 Montgomery Village Ave
Ste G-13
Montgomry Village, MD 20886-5026
Phone (301) 977-4100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0004875 | MD | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1376538751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19261 MONTGOMERY VILLAGE AVE",
"address_2": "STE G-13",
"city": "MONTGOMRY VILLAGE",
"state": "MD",
"postal_code": "208865026",
"telephone_number": "301-977-4100",
"fax_number": "301-977-4101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19261 MONTGOMERY VILLAGE AVE",
"address_2": "STE G-13",
"city": "MONTGOMRY VILLAGE",
"state": "MD",
"postal_code": "208865026",
"telephone_number": "301-977-4100",
"fax_number": "301-977-4101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYES",
"first_name": "PROTACIO",
"middle_name": "AZARCON",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-13",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MD",
"license": "D0004875",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montgomry Village, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.