Healthcare Provider Details

I. General information

NPI: 1093807869
Provider Name (Legal Business Name): PEDRO M RIVERA-VELAZQUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9131 PISCATAWAY RD STE 450
CLINTON MD
20735-2543
US

IV. Provider business mailing address

9131 PISCATAWAY RD SUITE 450
CLINTON MD
20735-2508
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-6700
  • Fax: 301-868-3017
Mailing address:
  • Phone: 301-868-6700
  • Fax: 301-868-3017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberD0054514
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: