Provider Demographics
NPI:1093807869
Name:RIVERA-VELAZQUEZ, PEDRO M (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:M
Last Name:RIVERA-VELAZQUEZ
Suffix:
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 1:9131 PISCATAWAY RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2508
Mailing Address - Country:US
Mailing Address - Phone:301-868-6700
Mailing Address - Fax:301-868-3017
Practice Address - Street 1:9131 PISCATAWAY RD STE 450
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2543
Practice Address - Country:US
Practice Address - Phone:301-868-6700
Practice Address - Fax:301-868-3017
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054514173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
808821Medicare ID - Type Unspecified
H12164Medicare UPIN