Provider Demographics
NPI:1134132418
Name:FIGUEROA, EDMUNDO E (MD)
Entity Type:Individual
Prefix:
First Name:EDMUNDO
Middle Name:E
Last Name:FIGUEROA
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 1:415 MORRIS ST STE 301
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1853
Mailing Address - Country:US
Mailing Address - Phone:304-345-4285
Mailing Address - Fax:304-345-8564
Practice Address - Street 1:415 MORRIS ST STE 301
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1853
Practice Address - Country:US
Practice Address - Phone:304-345-4285
Practice Address - Fax:304-345-8564
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10943208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0129115000Medicaid
WVD49251Medicare UPIN
WV0129115000Medicaid