Healthcare Provider Details

I. General information

NPI: 1932184462
Provider Name (Legal Business Name): JASON W EDSALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/13/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 ROCKFORD ST EMERGENCY DEPARTMENT
MT AIRY NC
27030-5322
US

IV. Provider business mailing address

PO BOX 900035 ATTN LISA BROWER
RALEIGH NC
27675-9035
US

V. Phone/Fax

Practice location:
  • Phone: 336-786-6068
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101242157
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101242157
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101242157
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0101242157
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101242157
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101242157
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101242157
License Number StateVA
# 8
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number200101331
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: