1174663967 NPI number — NORMAN R EDWARDS MD LTD

Table of content: (NPI 1174663967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174663967 NPI number — NORMAN R EDWARDS MD LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORMAN R EDWARDS MD LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174663967
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6694
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23606-0694
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-874-0712
Provider Business Mailing Address Fax Number:
757-874-0691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 THIMBLE SHOALS BLVD
Provider Second Line Business Practice Location Address:
#404
Provider Business Practice Location Address City Name:
NEWPORT NEWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23606-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-873-0712
Provider Business Practice Location Address Fax Number:
757-873-0691
Provider Enumeration Date:
02/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
ROSS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
757-873-0712

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 005388 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 6261264 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4211797 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2122353 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".