Provider Demographics
NPI:1336168608
Name:PADRON, MARIA VIRGINIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:VIRGINIA
Last Name:PADRON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-2107
Mailing Address - Country:US
Mailing Address - Phone:201-861-7639
Mailing Address - Fax:908-994-7354
Practice Address - Street 1:433 68TH ST
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093-2409
Practice Address - Country:US
Practice Address - Phone:201-861-7639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0334332084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PID445604Medicare ID - Type Unspecified
NJB11459Medicare UPIN