Provider Demographics
NPI:1619958568
Name:CASADO, EDGAR (MD)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:
Last Name:CASADO
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:PO BOX 66799
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:04105-6799
Mailing Address - Country:US
Mailing Address - Phone:866-689-8860
Mailing Address - Fax:207-347-7401
Practice Address - Street 1:2014 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462
Practice Address - Country:US
Practice Address - Phone:617-243-6162
Practice Address - Fax:207-347-7401
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2097512085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA209751OtherTUFTS
MA243748OtherHARVARD PILIGRIM
MA01-50100Medicaid
MAJ23643OtherBLUE CROSS/ BLUE SHIELD
H39355Medicare UPIN
MA209751OtherTUFTS