Edgewood Medical LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD10514 Issued in RI

Legal business name

EDGEWOOD MEDICAL LLC

Practice address

251 Park Ave
2ND Floor
Cranston, RI 02905-2647

Phone

(401) 275-0700

Fax

(401) 275-0775

NPI assigned

Jul 23, 2007

Last updated

Sep 9, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jose R Polanco, MDNPI 1609850411

Title

Medical Director

Phone

(401) 275-0700

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jose Roman Polanco, MD

  • Internal Medicine Physician
  • North Easton, MA
  • NPI 1609850411
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220918400000",
    "number": "1952501421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 PARK AVE",
            "address_2": "2ND FLOOR",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029052647",
            "telephone_number": "401-275-0700",
            "fax_number": "401-275-0775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 PARK AVE",
            "address_2": "2ND FLOOR",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029052647",
            "telephone_number": "401-275-0700",
            "fax_number": "401-275-0775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-23",
        "last_updated": "2008-09-09",
        "status": "A",
        "authorized_official_last_name": "POLANCO",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "401-275-0700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "MD10514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony Paul Eacuello
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• Jennifer Ebanks
• Ec Therapy Solutions LLC
• Jennifer L Edge, LICSW
• Sofia Edlund-Wynn
• Edward T. Ferry, DDS Inc
• Merle Edwards-Orr
• Michael S Edwards, DPT
• Ef Advantage LLC

• Internal Medicine Physician in Cranston, RI
• Providers in Cranston, RI by specialty
• Internal Medicine Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.