Provider Demographics
NPI:1457569451
Name:EDMUNDO E. FIGUEROA, MD INC
Entity type:Organization
Organization Name:EDMUNDO E. FIGUEROA, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDMUNDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-345-5285
Mailing Address - Street 1:415 MORRIS ST STE 301
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1853
Mailing Address - Country:US
Mailing Address - Phone:304-345-4285
Mailing Address - Fax:304-345-8564
Practice Address - Street 1:415 MORRIS ST STE 301
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1853
Practice Address - Country:US
Practice Address - Phone:304-345-4285
Practice Address - Fax:304-345-8564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10942208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVD49251Medicare UPIN
WV0428495Medicare ID - Type Unspecified
WV01299115000Medicare ID - Type Unspecified