Provider Demographics
NPI:1518234400
Name:EDGE MEDICAL RESEARCH, LLC
Entity Type:Organization
Organization Name:EDGE MEDICAL RESEARCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARDONA HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-438-2225
Mailing Address - Street 1:PASEO LOS CORALES II
Mailing Address - Street 2:728 MAR DE BENGAL
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4538
Mailing Address - Country:US
Mailing Address - Phone:787-438-2225
Mailing Address - Fax:
Practice Address - Street 1:CALLE TOMAS DAVILA #1
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-2736
Practice Address - Country:US
Practice Address - Phone:787-438-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15911208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty