Provider Demographics
NPI:1912006503
Name:COLON NEGRON, EDGAR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:
Last Name:COLON NEGRON
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:P.O.BOX 7891
Mailing Address - Street 2:PMB 509
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00959-7891
Mailing Address - Country:US
Mailing Address - Phone:787-789-1919
Mailing Address - Fax:787-789-1921
Practice Address - Street 1:AVE. CASA LINDA NUM. 1 SUITE 101
Practice Address - Street 2:ENTRADA AMERICAN MILITARY ACADEMY
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-0000
Practice Address - Country:US
Practice Address - Phone:787-789-1919
Practice Address - Fax:787-789-1921
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR90822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF82910Medicare UPIN
PR81000Medicare ID - Type Unspecified