Healthcare Provider Details

I. General information

NPI: 1588602304
Provider Name (Legal Business Name): RICHARD DAVID EDRINGTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 EXECUTIVE DR STE 304
RALEIGH NC
27609-7492
US

IV. Provider business mailing address

3300 EXECUTIVE DR STE 304
RALEIGH NC
27609-7492
US

V. Phone/Fax

Practice location:
  • Phone: 919-576-8680
  • Fax: 919-576-8699
Mailing address:
  • Phone: 919-576-8680
  • Fax: 919-576-8699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number23520
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: