Provider Demographics
NPI:1780645374
Name:MEJIA, EDGAR RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:RAFAEL
Last Name:MEJIA
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 1:760 MARKET ST.
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07513
Mailing Address - Country:US
Mailing Address - Phone:973-523-8083
Mailing Address - Fax:973-523-1133
Practice Address - Street 1:760 MARKET ST.
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07513
Practice Address - Country:US
Practice Address - Phone:973-523-8083
Practice Address - Fax:973-523-1133
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA059882208000000X
NJ25MA05988200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6257402Medicaid
NJ6257402Medicaid