Provider Demographics
NPI:1326037698
Name:PACHECO MALDONADO, PEDRO ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:ANTONIO
Last Name:PACHECO MALDONADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:HC 66 BOX 5323
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-9606
Mailing Address - Country:US
Mailing Address - Phone:787-863-5882
Mailing Address - Fax:787-863-1114
Practice Address - Street 1:ROAD 985 KM 4.1 (BOX 5323)
Practice Address - Street 2:BO. FLORENCIO
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-863-5882
Practice Address - Fax:787-863-1114
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR134682083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82238Medicare ID - Type Unspecified
PRI-15783Medicare UPIN