Organization
EDGEWOOD MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE R POLANCO MD (MEDICAL DIRECTOR)
(401) 275-0700
Entity
Organization
Contact information
Practice address
251 PARK AVE, 2ND FLOOR, CRANSTON, RI 02905-2647
(401) 275-0700
(401) 275-0775
Mailing address
251 PARK AVE, 2ND FLOOR, CRANSTON, RI 02905-2647
(401) 275-0700
(401) 275-0775
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD10514
RI
Other
Enumeration date
07/23/2007
Last updated
09/09/2008
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