Provider Demographics
NPI:1134197221
Name:CONSTANTINO, ANNE ENCARNACION AGRAVIADOR (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE ENCARNACION
Middle Name:AGRAVIADOR
Last Name:CONSTANTINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10401 HOSPITAL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3110
Mailing Address - Country:US
Mailing Address - Phone:301-877-4540
Mailing Address - Fax:301-856-3470
Practice Address - Street 1:6900 N PECOS RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-4400
Practice Address - Country:US
Practice Address - Phone:301-877-4540
Practice Address - Fax:301-856-3470
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD0432382084N0400X
MDD00740072084N0400X
KY385482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD312507600Medicaid
MD342916ZAPQOtherMEDICARE GROUP MEMBER PTAN
MD312507600Medicaid
KY64084585Medicaid
KY0050855Medicare PIN