MEDICARE: BEATRIX K EDMONDS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	0101052205	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C04588	OTHER	VA	MEDICARE GROUP NUMBER
2	CK5559	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366550196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATRIX K EDMONDS MD

Provider Business Mailing Address
First Line	:	801 YORK ST
Second Line	:
City	:	MANITOWOC
State	:	WI
Zip	:	54220-4630
Country	:	US
Telephone Number	:	920-663-9008
Fax Number	:	920-684-1439

Provider Business Practice Location Address
First Line	:	1157 FIRST COLONIAL RD STE 300
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2432
Country	:	US
Telephone Number	:	757-333-8001
Fax Number	:	757-333-8002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	10/14/2025

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Directions to “ BEATRIX K EDMONDS MD” Practice Location

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