Healthcare Provider Details

I. General information

NPI: 1851532402
Provider Name (Legal Business Name): EDWARD DOUGLAS HUTSON JR. D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 N 3RD ST FIRST FLOOR
EASTON PA
18042-7737
US

IV. Provider business mailing address

42 N 3RD ST FIRST FLOOR
EASTON PA
18042-7737
US

V. Phone/Fax

Practice location:
  • Phone: 610-253-4821
  • Fax:
Mailing address:
  • Phone: 610-253-4821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC005918
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: