MEDICARE: EDGARDO MALDONADO MD

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	MD423559	PA
2	207R00000X	Internal Medicine Physician	2012-00904	NC

General Provider Information

NPI Number	:	1346279981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDGARDO MALDONADO MD

Provider Business Mailing Address
First Line	:	1409 YANCEYVILLE ST STE B
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-6961
Country	:	US
Telephone Number	:	743-223-2033
Fax Number	:	743-223-4186

Provider Business Practice Location Address
First Line	:	1409 YANCEYVILLE ST STE B
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-6961
Country	:	US
Telephone Number	:	743-223-2033
Fax Number	:	743-223-4186

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	01/03/2023

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