Healthcare Provider Details

I. General information

NPI: 1053419614
Provider Name (Legal Business Name): ROBERTO PEDRAZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9420 KEY WEST AVE. #420
ROCKVILLE MD
20850
US

IV. Provider business mailing address

25 CROSSROADS DRIVE SUITE 306
OWINGS MILLS MD
21117
US

V. Phone/Fax

Practice location:
  • Phone: 301-258-1919
  • Fax: 301-258-9180
Mailing address:
  • Phone: 443-738-2872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberD0056187
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: