Healthcare Provider Details

I. General information

NPI: 1720874464
Provider Name (Legal Business Name): EDWIN ALBERTO VEGA VARGAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

IV. Provider business mailing address

21150 STAKED PLAINS DRIVE
CYPRESS TX
77433
US

V. Phone/Fax

Practice location:
  • Phone: 603-695-2940
  • Fax:
Mailing address:
  • Phone: 281-684-4272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberPENDING
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: