Provider Demographics
NPI:1902887177
Name:PEDRAZA, NOEMI MARTHA (MD)
Entity Type:Individual
Prefix:DR
First Name:NOEMI
Middle Name:MARTHA
Last Name:PEDRAZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:77 MASSACHUSETTS AVE
Mailing Address - Street 2:E23-395
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4301
Mailing Address - Country:US
Mailing Address - Phone:617-253-4988
Mailing Address - Fax:
Practice Address - Street 1:77 MASSACHUSETTS AVE
Practice Address - Street 2:MIT MEDICAL E23/289
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4301
Practice Address - Country:US
Practice Address - Phone:617-253-7824
Practice Address - Fax:617-258-0428
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA33176207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
A66090Medicare UPIN