Healthcare Provider Details

I. General information

NPI: 1902887177
Provider Name (Legal Business Name): NOEMI MARTHA PEDRAZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 MASSACHUSETTS AVE MIT MEDICAL E23/289
CAMBRIDGE MA
02139-4301
US

IV. Provider business mailing address

77 MASSACHUSETTS AVE E23-395
CAMBRIDGE MA
02139-4301
US

V. Phone/Fax

Practice location:
  • Phone: 617-253-7824
  • Fax: 617-258-0428
Mailing address:
  • Phone: 617-253-4988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number33176
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: