Healthcare Provider Details

I. General information

NPI: 1023019551
Provider Name (Legal Business Name): EDGAR C CORDERO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 MCKEAN AVE
DONORA PA
15033-1002
US

IV. Provider business mailing address

627 MCKEAN AVE PO BOX 641
DONORA PA
15033-1002
US

V. Phone/Fax

Practice location:
  • Phone: 724-379-7250
  • Fax: 724-379-7608
Mailing address:
  • Phone: 724-379-7250
  • Fax: 724-379-7608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD034650L
License Number StatePA

VIII. Authorized Official

Name: DR. EDGAR CORTAZAR CORDERO
Title or Position: PRESIDENT
Credential: MD
Phone: 724-379-7250