MEDICARE: DR. EDWIDGE J JACINTHE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	M6478	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093837445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWIDGE J JACINTHE M.D.

Provider Business Mailing Address
First Line	:	2450 LOUISIANA ST
Second Line	:	STUITE 400-322
City	:	HOUSTON
State	:	TX
Zip	:	77006-2380
Country	:	US
Telephone Number	:	281-260-0087
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 LOUISIANA ST
Second Line	:	STUITE 400-322
City	:	HOUSTON
State	:	TX
Zip	:	77006-2380
Country	:	US
Telephone Number	:	281-260-0087
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2007
Last Update Date	:	02/20/2014

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