Healthcare Provider Details

I. General information

NPI: 1740190628
Provider Name (Legal Business Name): EDWARD HARRISON MCGRATH
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 PHILADELPHIA PIKE
CLAYMONT DE
19703-3108
US

IV. Provider business mailing address

2138 WHARTON RD
GLENSIDE PA
19038-5326
US

V. Phone/Fax

Practice location:
  • Phone: 302-798-6632
  • Fax:
Mailing address:
  • Phone: 484-560-1613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: