Provider Demographics
NPI:1114990355
Name:GUILLAUME, EDOUARD (MD)
Entity Type:Individual
Prefix:
First Name:EDOUARD
Middle Name:
Last Name:GUILLAUME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LOUIS JEAN
Other - Middle Name:EDOUARD
Other - Last Name:GUILLAUME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2687 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-1235
Mailing Address - Country:US
Mailing Address - Phone:718-434-1924
Mailing Address - Fax:516-374-9576
Practice Address - Street 1:2687 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-1235
Practice Address - Country:US
Practice Address - Phone:718-434-1924
Practice Address - Fax:516-374-9576
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147272207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology