Provider Demographics
NPI:1932117421
Name:MALDENADO-VIERA, LOURDES (MD)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:MALDENADO-VIERA
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:PO BOX 622
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-0622
Mailing Address - Country:US
Mailing Address - Phone:908-300-3700
Mailing Address - Fax:201-847-1555
Practice Address - Street 1:2100 WESCOTT DR
Practice Address - Street 2:O.R.
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4603
Practice Address - Country:US
Practice Address - Phone:908-788-6180
Practice Address - Fax:908-788-6361
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05785200174400000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
727099Medicare PIN
F32819Medicare UPIN