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General NPI Number Information
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NPI Number | 1184889271
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Entity Type | Individual
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Provider Name | EDWING GERARDO MEDINA CARCAMO M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/28/2008
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 750 BRUNSWICK AVE
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City | TRENTON
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State | NJ
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Zip | 08638-4143
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Country | US
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Telephone | 609-394-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 1 CAPITAL WAY
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City | PENNINGTON
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State | NJ
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Zip | 08534-2520
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Country | US
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Telephone | 609-303-4000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 25MA08361900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA08361900
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License Number State | NJ
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