Provider Demographics
NPI:1891746624
Name:BERMUDEZ MORENO, EDGARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:
Last Name:BERMUDEZ MORENO
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 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 LUKES MEMORIAL HOSPITAL
Practice Address - Street 2:909 AVE TITO CASTRO CARR 14
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-813-0550
Practice Address - Fax:787-813-0566
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10593207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41084Medicare UPIN
PR0083459Medicare PIN