Provider Demographics
NPI:1639269301
Name:DR.EDGARDO BERMUDEZ,SERVICIOS CARDIOVASCULARES, PSC
Entity Type:Organization
Organization Name:DR.EDGARDO BERMUDEZ,SERVICIOS CARDIOVASCULARES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMUDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-813-0550
Mailing Address - Street 1:P O BOX 7334
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7334
Mailing Address - Country:US
Mailing Address - Phone:787-813-0550
Mailing Address - Fax:787-813-0566
Practice Address - Street 1:SAINT LUKE MEMORIAL HOSPITAL
Practice Address - Street 2:909 AVE. TITO CASTRO TORRE MEDICA SUITE 712
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-813-0550
Practice Address - Fax:787-813-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10593207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085356Medicare UPIN