Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 245011 | MA |
N | 207R00000X | Internist | 245011 | MA |
N | 111NI0900X | Internist | 245011 | MA |
NPI | 1013237924 |
---|---|
Provider Name | Richard Pedro |
First Address | Boston, MA 02118-2308 |
Second Address | Worcester, MA 01655-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2010 |
Last Update Date | 05/04/2011 |