Healthcare Provider Details

I. General information

NPI: 1215317185
Provider Name (Legal Business Name): PEDRO URDAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST
BOSTON MA
02111-1552
US

IV. Provider business mailing address

62 BOYLSTON ST 619
BOSTON MA
02116-4799
US

V. Phone/Fax

Practice location:
  • Phone: 973-975-7456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD465934
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD465934
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: