MEDICARE: KENNETH EDGAR MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	MD065024L	PA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300084169	OTHER	PA	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000268720	OTHER	PA	BC BS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1649278904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH EDGAR MD

Provider Business Mailing Address
First Line	:	5655 HUDSON DR STE 210
Second Line	:	ARIS RADIOLOGY
City	:	HUDSON
State	:	OH
Zip	:	44236-4455
Country	:	US
Telephone Number	:	330-655-1869
Fax Number	:	330-655-3828

Provider Business Practice Location Address
First Line	:	5655 HUDSON DR STE 210
Second Line	:	ARIS RADIOLOGY
City	:	HUDSON
State	:	OH
Zip	:	44236-4455
Country	:	US
Telephone Number	:	330-655-1869
Fax Number	:	330-655-3828

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	12/19/2016

5655 HUDSON DR STE 210
HUDSON, OH
44236-4455

Practice Phone: 330-655-1869
Practice Fax: 330-655-3828