Healthcare Provider Details

I. General information

NPI: 1740215771
Provider Name (Legal Business Name): THOMAS BERNARD EDWARDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 SOUTH ST
PITTSFIELD MA
01201-6803
US

IV. Provider business mailing address

369 SOUTH ST
PITTSFIELD MA
01201-6803
US

V. Phone/Fax

Practice location:
  • Phone: 413-443-4826
  • Fax: 413-443-4488
Mailing address:
  • Phone: 413-443-4826
  • Fax: 413-443-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number156926
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: