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NPI Code Detail

MEDICARE: DR. EDWIN JESS SUPIT M.D.

MEDICARE: DR. EDWIN JESS SUPIT 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
1207R00000XInternal Medicine PhysicianM001421GU

General Provider Information

NPI Number : 1518904812
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWIN JESS SUPIT M.D.
Provider Business Mailing Address
First Line : 388 YPAO RD
Second Line :
City : TAMUNING
State : GU
Zip : 96913-3701
Country : US
Telephone Number : 671-646-8881
Fax Number : 671-646-1292
Provider Business Practice Location Address
First Line : 388 YPAO RD
Second Line :
City : TAMUNING
State : GU
Zip : 96913-3701
Country : US
Telephone Number : 671-646-8881
Fax Number : 671-646-1292
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2006
Last Update Date : 11/13/2025

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