1174663967 NPI number — NORMAN R EDWARDS MD LTD

Table of Contents

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".




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