MEDICARE: EDGARDO QUINTANA- PAGAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	237441	NY
2	208D00000X	General Practice Physician	237441	NY
3	208D00000X	General Practice Physician	16273	PR
4	207L00000X	Anesthesiology Physician	16273	PR

General Provider Information

NPI Number	:	1245434679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDGARDO QUINTANA- PAGAN MD

Provider Business Mailing Address
First Line	:	20 AVE LMM STE 1
Second Line	:	VILLA BLANCA PMB 509
City	:	CAGUAS
State	:	PR
Zip	:	00725-3740
Country	:	US
Telephone Number	:	787-432-6583
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 AVE RAFAEL CORDERO
Second Line	:	SUITE 140 PMB 509
City	:	CAGUAS
State	:	PR
Zip	:	00725-3740
Country	:	US
Telephone Number	:	787-432-6583
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	03/24/2021

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