Provider Demographics
NPI:1174596720
Name:AQUINO, EDWIN ABELLA (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:ABELLA
Last Name:AQUINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 SIR THOMAS CT
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-4840
Mailing Address - Country:US
Mailing Address - Phone:717-541-5406
Mailing Address - Fax:717-541-5449
Practice Address - Street 1:845 SIR THOMAS CT
Practice Address - Street 2:SUITE 10
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4840
Practice Address - Country:US
Practice Address - Phone:717-541-5406
Practice Address - Fax:717-541-5449
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027976E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA192535OtherMEDICARE PTAN
PAC31290Medicare UPIN
PA134591Medicare PIN