MEDICARE: DR. EDITH CALDERON M.D.

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	208000000X	Pediatrics Physician	10305	PR

General Provider Information

NPI Number	:	1952384257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDITH CALDERON M.D.

Provider Business Mailing Address
First Line	:	COND MONTE REAL
Second Line	:	BUZON 123
City	:	SAN JUAN
State	:	PR
Zip	:	00926-8211
Country	:	US
Telephone Number	:	787-748-3504
Fax Number	:

Provider Business Practice Location Address
First Line	:	STATE ROAD 3 KM 8.3 , 65TH INFANTERIA AVE.
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00984
Country	:	US
Telephone Number	:	787-757-1800
Fax Number	:

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	07/08/2007

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