Healthcare Provider Details

I. General information

NPI: 1518690171
Provider Name (Legal Business Name): EDWARD TELMO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 14010 BOX ANDERSEN
APO AP
96543-4010
US

IV. Provider business mailing address

UNIT 14010 BOX ANDERSEN
APO AP
96543-4010
US

V. Phone/Fax

Practice location:
  • Phone: 671-864-8559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102208203
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: