Provider Demographics
NPI:1366402091
Name:QUINTERO-MALDONADO, EDGAR N (MD)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:N
Last Name:QUINTERO-MALDONADO
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:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-256-5555
Mailing Address - Fax:787-256-5454
Practice Address - Street 1:CARRETERA PR 3 KM19 HM9
Practice Address - Street 2:EAST MEDICAL & PROFESSIONAL CENTER
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-2379
Practice Address - Country:US
Practice Address - Phone:787-256-5555
Practice Address - Fax:787-256-5555
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10100208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82491Medicare ID - Type Unspecified