Provider Demographics
NPI:1639266539
Name:TOLENTINO, EDGAR E (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:E
Last Name:TOLENTINO
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 1:5500 RIDGE RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129
Mailing Address - Country:US
Mailing Address - Phone:440-743-0426
Mailing Address - Fax:440-743-7466
Practice Address - Street 1:5500 RIDGE RD
Practice Address - Street 2:SUITE 115
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129
Practice Address - Country:US
Practice Address - Phone:440-743-0426
Practice Address - Fax:440-743-7466
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35034415208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0199244Medicaid
OH0199244Medicaid
0372932Medicare ID - Type Unspecified