Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 048189 | NY |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2760 | PR |
NPI | 1003897521 |
---|---|
Provider Name | Dr. Edgar Amador Belardo |
First Address | Guaynabo, PR 00969-2807 |
Second Address | Guaynabo, PR 00969-2807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 01/06/2016 |