Provider Demographics
NPI:1023214764
Name:COLON-LEDEE, EDGARDO MIGUEL (MD)
Entity Type:Individual
Prefix:
First Name:EDGARDO
Middle Name:MIGUEL
Last Name:COLON-LEDEE
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 79770
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-9770
Mailing Address - Country:US
Mailing Address - Phone:787-724-8918
Mailing Address - Fax:787-724-8917
Practice Address - Street 1:279 CALLE CONVENTO
Practice Address - Street 2:SANTURCE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3205
Practice Address - Country:US
Practice Address - Phone:787-724-8918
Practice Address - Fax:787-724-8917
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6943208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery