Provider Demographics
NPI:1942224621
Name:PARDO, MORIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MORIS
Middle Name:
Last Name:PARDO
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 1:163 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1639
Mailing Address - Country:US
Mailing Address - Phone:413-733-2050
Mailing Address - Fax:
Practice Address - Street 1:299 CAREW ST STE 207
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2360
Practice Address - Country:US
Practice Address - Phone:413-733-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153070174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3177041Medicaid
G61223Medicare UPIN
A23210Medicare ID - Type Unspecified