Provider Demographics
NPI:1255508735
Name:PENA SALAZAR, ADOLFO MOISES (MD)
Entity Type:Individual
Prefix:DR
First Name:ADOLFO
Middle Name:MOISES
Last Name:PENA SALAZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ADOLFO
Other - Middle Name:
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:119 BELMONT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2903
Practice Address - Country:US
Practice Address - Phone:085-334-8515
Practice Address - Fax:508-733-4764
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY43326207R00000X, 208M00000X
MA265416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist