Healthcare Provider Details

I. General information

NPI: 1851334544
Provider Name (Legal Business Name): EDGARD MARIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 CALLE SANTA CRUZ TORRE DE SAN PABLO SUITE 803B
BAYAMON PR
00961-7031
US

IV. Provider business mailing address

STREET 17 URB.FAIR VIEW L-17
SAN JUAN PR
00926-8119
US

V. Phone/Fax

Practice location:
  • Phone: 787-785-7760
  • Fax: 787-786-0275
Mailing address:
  • Phone: 787-785-7760
  • Fax: 787-786-0275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9943
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number9943
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: