Healthcare Provider Details

I. General information

NPI: 1386651073
Provider Name (Legal Business Name): MICHAEL A EDWARDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40-42 ASBURY ST
SOUTH HAMILTON MA
01982
US

IV. Provider business mailing address

40-42 ASBURY ST
SOUTH HAMILTON MA
01982
US

V. Phone/Fax

Practice location:
  • Phone: 978-468-4101
  • Fax: 978-468-7067
Mailing address:
  • Phone: 978-468-4101
  • Fax: 978-468-7067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47195
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: