Provider Demographics
NPI:1689605321
Name:PLAMENCO, PEDRO S (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:S
Last Name:PLAMENCO
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 1:9921 4TH AVE
Mailing Address - Street 2:LL1-LL2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-8347
Mailing Address - Country:US
Mailing Address - Phone:718-238-5311
Mailing Address - Fax:718-748-5350
Practice Address - Street 1:9921 4TH AVE
Practice Address - Street 2:LL1-LL2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-8347
Practice Address - Country:US
Practice Address - Phone:718-238-5311
Practice Address - Fax:718-748-5350
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105469207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B16760Medicare UPIN