Provider Demographics
NPI:1992907810
Name:CORDERO, EDGAR C (MD)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:C
Last Name:CORDERO
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 1:627 MCKEAN AVE
Mailing Address - Street 2:PO BOX 641
Mailing Address - City:DONORA
Mailing Address - State:PA
Mailing Address - Zip Code:15033-1002
Mailing Address - Country:US
Mailing Address - Phone:724-379-7250
Mailing Address - Fax:724-379-7608
Practice Address - Street 1:627 MCKEAN AVE
Practice Address - Street 2:
Practice Address - City:DONORA
Practice Address - State:PA
Practice Address - Zip Code:15033-1002
Practice Address - Country:US
Practice Address - Phone:724-379-7250
Practice Address - Fax:724-379-7608
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034650L2086H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086H0002XAllopathic & Osteopathic PhysiciansSurgeryHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0927550Medicaid
PA113048Medicare ID - Type Unspecified
PAB36921Medicare UPIN