Provider Demographics
NPI:1093771511
Name:SAMANIEGO, EDGAR A (MD)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:A
Last Name:SAMANIEGO
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 1:15 CHERRY LN NE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-9110
Mailing Address - Country:US
Mailing Address - Phone:319-333-4460
Mailing Address - Fax:
Practice Address - Street 1:200 HAWKINS DR # 2007
Practice Address - Street 2:ROY CARVER PAVILION
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-8755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-429152084A2900X, 2084N0400X, 2084V0102X, 2085R0204X
IL036-1374202084N0400X
WI1405-TEP2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology