Provider Demographics
NPI:1285956037
Name:EDC OF VOLUSIA, LLC
Entity type:Organization
Organization Name:EDC OF VOLUSIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-322-6111
Mailing Address - Street 1:1055 N DIXIE FWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-6201
Mailing Address - Country:US
Mailing Address - Phone:386-423-0505
Mailing Address - Fax:386-423-0515
Practice Address - Street 1:780 DUNLAWTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4901
Practice Address - Country:US
Practice Address - Phone:386-322-6111
Practice Address - Fax:386-322-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98466207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty