Provider Demographics
NPI:1265491864
Name:ROIG CASANOVA, EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:ROIG CASANOVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDWIN
Other - Middle Name:
Other - Last Name:ROIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4633 AVE ISLA VERDE
Mailing Address - Street 2:CASTILLO DEL MAR APT.103
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-5300
Mailing Address - Country:US
Mailing Address - Phone:787-200-9462
Mailing Address - Fax:
Practice Address - Street 1:809 CALLE HIPODROMO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2523
Practice Address - Country:US
Practice Address - Phone:787-200-9462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR04611174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD08341Medicare UPIN
PR25721Medicare ID - Type Unspecified