Provider Demographics
NPI:1851334544
Name:MARIN, EDGARD (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGARD
Middle Name:
Last Name:MARIN
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:STREET 17
Mailing Address - Street 2:URB.FAIR VIEW L-17
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-8119
Mailing Address - Country:US
Mailing Address - Phone:787-785-7760
Mailing Address - Fax:787-786-0275
Practice Address - Street 1:68 CALLE SANTA CRUZ TORRE DE SAN PABLO
Practice Address - Street 2:SUITE 803B
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7031
Practice Address - Country:US
Practice Address - Phone:787-785-7760
Practice Address - Fax:787-786-0275
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9943207Q00000X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89849Medicare PIN
PRH28773Medicare UPIN