Individual
DR. EDWARD COSTA FOURGAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 E MOUNTAIN BLVD, WILKES BARRE, PA 18711-0027
(570) 808-7779
(570) 808-5390
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
2085D0003X
Diagnostic Neuroimaging (Radiology) Physician
8232714-1205
UT
2085N0700X
Neuroradiology Physician
MD448590
PA
2085R0202X
Diagnostic Radiology Physician
4301088547
MI
2085R0202X
Diagnostic Radiology Physician
Primary
MD448590
PA
Other
Enumeration date
05/31/2007
Last updated
08/19/2020
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