Healthcare Provider Details

I. General information

NPI: 1588865067
Provider Name (Legal Business Name): DR. EGLE D. PEDINI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 ROUTE 28
HARWICH PORT MA
02646-1911
US

IV. Provider business mailing address

651 ROUTE 28
HARWICH PORT MA
02646-1911
US

V. Phone/Fax

Practice location:
  • Phone: 508-432-3029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number32218
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: