Healthcare Provider Details

I. General information

NPI: 1619898731
Provider Name (Legal Business Name): PEDRO HENRIQUE CAMPERONI LUCIANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HIGHLAND AVE
SALEM MA
01970-2714
US

IV. Provider business mailing address

81 HIGHLAND AVE
SALEM MA
01970-2714
US

V. Phone/Fax

Practice location:
  • Phone: 978-354-4009
  • Fax: 978-825-6312
Mailing address:
  • Phone: 978-354-4009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3020301
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: