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Individual
MIA EDGAR
Active
Individual
MIA EDGAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
207L00000X
Anesthesiology Physician
Primary
1891189668
VA
208D00000X
General Practice Physician
Primary
0101261131
VA
Other
Enumeration date
03/19/2015
Last updated
09/18/2026
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