Manuel Eduardo Bravo, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

D09284 Issued in MD

Practice address

19201 Montgomery Village Ave
Ste A12
Montgomry Village, MD 20886-5057

Phone

(301) 670-0070

Fax

(301) 977-4916

NPI assigned

Jun 15, 2005

Reactivated

Aug 7, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508861808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19201 MONTGOMERY VILLAGE AVE",
            "address_2": "STE A12",
            "city": "MONTGOMRY VILLAGE",
            "state": "MD",
            "postal_code": "208865057",
            "telephone_number": "301-670-0070",
            "fax_number": "301-977-4916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19201 MONTGOMERY VILLAGE AVE",
            "address_2": "STE A12",
            "city": "MONTGOMRY VILLAGE",
            "state": "MD",
            "postal_code": "208865057",
            "telephone_number": "301-670-0070",
            "fax_number": "301-977-4916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAVO",
        "first_name": "MANUEL",
        "middle_name": "EDUARDO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-15",
        "last_updated": "2007-07-08",
        "deactivation_date": "2006-03-17",
        "reactivation_date": "2006-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D09284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Louis J Heindel, DNP
• Patricia Hughes, NP
• Bruce Robert Knolmayer, M.D.
• Corina M Millo, M.D.
• Protacio Azarcon Reyes, MD

• Pediatrics Physician in Montgomry Village, MD
• Providers in Montgomry Village, MD by specialty
• Pediatrics Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.