Healthcare Provider Details

I. General information

NPI: 1568490019
Provider Name (Legal Business Name): EDWARD EMMETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE STREET GROUND SILVERSTEIN BLDG
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

3400 SPRUCE ST GROUND SILVERSTEIN BLDG
PHILADELPHIA PA
19104-4206
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-6963
  • Fax: 215-662-4430
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD060125L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: