Provider Demographics
NPI:1740394618
Name:MARIA, PEDRO P (DO)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:P
Last Name:MARIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-1311
Mailing Address - Country:US
Mailing Address - Phone:718-920-4531
Mailing Address - Fax:
Practice Address - Street 1:3400 BAINBRIDGE AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2404
Practice Address - Country:US
Practice Address - Phone:718-920-4531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249007208800000X
PAOS012681208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1724343OtherPERSONAL CHOICE
PA1724343OtherHIGHMARK BLUE SHIELD
PA1012337800001Medicaid
PA34935OtherHEALTH PARTNERS
PA2392878000OtherKEYSTONE IBC
PA1724343OtherPERSONAL CHOICE
PA089730JL1Medicare PIN