Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | D0056187 | MD |
NPI | 1053419614 |
---|---|
Provider Name | Roberto Pedraza |
First Address | Owings Mills, MD 21117 |
Second Address | Rockville, MD 20850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
398641101 | (05) | MD |
H94882 | (02) |