Healthcare Provider Details

I. General information

NPI: 1144333428
Provider Name (Legal Business Name): CHRISTOPHER M EDWARDS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 DRESDEN AVE
GARDINER ME
04345-2615
US

IV. Provider business mailing address

152 DRESDEN AVE
GARDINER ME
04345-2615
US

V. Phone/Fax

Practice location:
  • Phone: 207-582-6608
  • Fax: 207-582-2258
Mailing address:
  • Phone: 207-582-6608
  • Fax: 207-582-2258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number239417
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2255
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number2255
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: