Healthcare Provider Details

I. General information

NPI: 1922918002
Provider Name (Legal Business Name): EDMUND JOHN WARD III
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 BUCK RD STE 3
HOLLAND PA
18966-1751
US

IV. Provider business mailing address

114 MEMORY LN
TELFORD PA
18969-2259
US

V. Phone/Fax

Practice location:
  • Phone: 267-270-5527
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: