Healthcare Provider Details

I. General information

NPI: 1356575146
Provider Name (Legal Business Name): HENRY L EDINGTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 POWELL ST STE 910
OAKLAND CA
94608-1811
US

IV. Provider business mailing address

425 UNIVERSITY AVE STE 140
SACRAMENTO CA
95825-6520
US

V. Phone/Fax

Practice location:
  • Phone: 510-834-5400
  • Fax: 510-834-5500
Mailing address:
  • Phone: 916-576-2936
  • Fax: 832-485-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: