Healthcare Provider Details

I. General information

NPI: 1255709002
Provider Name (Legal Business Name): CORA EDGER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 CENTRAL AVE
GREENVILLE OH
45331-1206
US

IV. Provider business mailing address

835 SWEITZER ST
GREENVILLE OH
45331-1007
US

V. Phone/Fax

Practice location:
  • Phone: 937-569-6996
  • Fax: 937-569-6079
Mailing address:
  • Phone: 937-548-1141
  • Fax: 937-569-6297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10002361A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004428RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: