| Edgewood Medical Llc | |
|
251 Park Ave 2nd Floor Cranston RI 02905-2647 | |
| (401) 275-0700 | |
| (401) 275-0775 |
| Full Name | Edgewood Medical Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 251 Park Ave, Cranston, Rhode Island |
| Authorized Official Name and Position | Jose R Polanco (MEDICAL DIRECTOR) |
| Authorized Official Contact | 4012750700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edgewood Medical Llc 251 Park Ave 2nd Floor Cranston RI 02905-2647 Ph: (401) 275-0700 | Edgewood Medical Llc 251 Park Ave 2nd Floor Cranston RI 02905-2647 Ph: (401) 275-0700 |
| NPI Number | 1952501421 |
|---|---|
| Provider Enumeration Date | 07/23/2007 |
| Last Update Date | 09/09/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952501421 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD10514 (Rhode Island) | Primary |
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