Healthcare Provider Details

I. General information

NPI: 1255920153
Provider Name (Legal Business Name): DR. EDWIN W. MALDONADO, M.D., P.L.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 06/06/2021
Certification Date: 06/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 BURNS RD STE 101
PALM BEACH GARDENS FL
33410-4352
US

IV. Provider business mailing address

1211 CREEKSIDE DR
WELLINGTON FL
33414-3137
US

V. Phone/Fax

Practice location:
  • Phone: 561-578-4582
  • Fax:
Mailing address:
  • Phone: 954-376-9281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWIN MALDONADO
Title or Position: OWNER
Credential: MD
Phone: 561-537-4582