Healthcare Provider Details

I. General information

NPI: 1457352353
Provider Name (Legal Business Name): EDWARD L. MCDOWELL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 05/23/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LEBANON ST
MOUNT AIRY NC
27030-2227
US

IV. Provider business mailing address

1201 W LEBANON ST
MOUNT AIRY NC
27030-2227
US

V. Phone/Fax

Practice location:
  • Phone: 336-648-8154
  • Fax: 336-648-8157
Mailing address:
  • Phone: 336-648-8154
  • Fax: 336-648-8157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number101127
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: