Provider Demographics
NPI:1548248818
Name:BARRUETO, FERMIN JR (MD)
Entity type:Individual
Prefix:DR
First Name:FERMIN
Middle Name:
Last Name:BARRUETO
Suffix:JR
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 1:832 CRYSTAL PALACE CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-2256
Mailing Address - Country:US
Mailing Address - Phone:443-465-4289
Mailing Address - Fax:
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:800-466-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057223174400000X
MDD57223207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD755602100Medicaid
MD451601000Medicaid
MDG607Medicare PIN
MD755602100Medicaid
MD613LMedicare PIN
MD613LP187Medicare PIN
MDH41021Medicare UPIN
MDP187Medicare PIN
MDR172Medicare PIN