Provider Demographics
NPI:1730111535
Name:VIEIRA, PEDRO (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:VIEIRA
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 1:1 W RIDGEWOOD AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2361
Mailing Address - Country:US
Mailing Address - Phone:201-251-6622
Mailing Address - Fax:
Practice Address - Street 1:1 W RIDGEWOOD AVE STE 302
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2361
Practice Address - Country:US
Practice Address - Phone:201-251-6622
Practice Address - Fax:201-251-6626
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07986600208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ101773Medicare PIN
NJ154192Medicare UPIN
NJ101773SU7Medicare PIN