Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 244DC | RI |
NPI | 1508802265 |
---|---|
Provider Name | Dr. Victor M Pedro |
First Address | Cranston, RI 02910-2346 |
Second Address | Cranston, RI 02910-2346 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 24/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T53637 | (02) | RI |