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Individual

EDWARD W. KIGGUNDU

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2000 FOUNDATION WAY, SUITE 1100, MARTINSBURG, WV 25401-9003
(304) 262-8800
(304) 262-8203
Mailing address
2234 COLONIAL BLVD, FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385

Taxonomy

Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
D0059245
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01050264
VI
05
1000034742
DE
05
3810004107
WV
01
5129591
MAMSI PROVIDER NUMBER
WV
01
5990540
CIGNA PROVIDER NUMBER
WV
01
61647309
CARE FIRST BCBS PROV. #
MD
01
7960384
AETNA PROVIDER NUMBER
WV
Enumeration date
09/23/2005
Last updated
09/15/2007
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