Provider Demographics
NPI:1346279981
Name:MALDONADO, EDGARDO (MD)
Entity Type:Individual
Prefix:
First Name:EDGARDO
Middle Name:
Last Name:MALDONADO
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 1:1409 YANCEYVILLE ST STE B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6961
Mailing Address - Country:US
Mailing Address - Phone:743-223-2033
Mailing Address - Fax:743-223-4186
Practice Address - Street 1:1409 YANCEYVILLE ST STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6961
Practice Address - Country:US
Practice Address - Phone:743-223-2033
Practice Address - Fax:743-223-4186
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423559207R00000X
NC2012-00904207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine