Provider Demographics
NPI:1700098472
Name:EDGHILL, MARY ANN SOTO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:SOTO
Last Name:EDGHILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2791 RICHMOND AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5859
Mailing Address - Country:US
Mailing Address - Phone:718-816-3710
Mailing Address - Fax:718-228-8141
Practice Address - Street 1:4771 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6315
Practice Address - Country:US
Practice Address - Phone:718-948-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236551208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54697GW791Medicare PIN