Healthcare Provider Details

I. General information

NPI: 1134176142
Provider Name (Legal Business Name): EARL WILBERT EDWARDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S GEORGE ST SUITE W-2
YORK PA
17403-4594
US

IV. Provider business mailing address

2200 S GEORGE ST SUITE W-2
YORK PA
17403-4594
US

V. Phone/Fax

Practice location:
  • Phone: 717-747-3220
  • Fax: 717-747-3338
Mailing address:
  • Phone: 717-747-3220
  • Fax: 717-747-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD427825
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD427825
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberBE8901060
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: