Provider Demographics
NPI:1619167871
Name:HIDALGO, EDGARDO C (MD)
Entity Type:Individual
Prefix:
First Name:EDGARDO
Middle Name:C
Last Name:HIDALGO
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 1:428 CHALAN SAN ANTONIO
Mailing Address - Street 2:P AND F PROFESSIONAL MANOR SUITE 101
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-647-4121
Mailing Address - Fax:671-646-4429
Practice Address - Street 1:428 CHALAN SAN ANTONIO
Practice Address - Street 2:P AND F PROFESSIONAL MANOR SUITE 101
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-647-4121
Practice Address - Fax:671-646-4429
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM001204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUI05864Medicare UPIN
GU56675Medicare PIN