Provider Demographics
NPI:1124087440
Name:DEL ROSARIO, EDWIN O (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:O
Last Name:DEL ROSARIO
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:PO BOX 741454
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1454
Mailing Address - Country:US
Mailing Address - Phone:817-431-5073
Mailing Address - Fax:
Practice Address - Street 1:8861 DAVIS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-0306
Practice Address - Country:US
Practice Address - Phone:817-431-5073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U1325OtherBCBS
TX129102306Medicaid
TXP00680231OtherRAILROAD MEDICARE
TXF68100Medicare UPIN
TX129102306Medicaid