Provider Demographics
NPI:1225539513
Name:CINTRON PASTRANA, MAITE ADRIANA (MD)
Entity Type:Individual
Prefix:
First Name:MAITE
Middle Name:ADRIANA
Last Name:CINTRON PASTRANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 LAKE AVE N
Mailing Address - Street 2:PSYCHIATRY DEPARTMENT
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-6604
Mailing Address - Country:US
Mailing Address - Phone:787-404-3777
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:PSYCHIATRY DEPARTMENT
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-0160
Practice Address - Country:US
Practice Address - Phone:508-801-9482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6141861390200000X
MA2852062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program