Healthcare Provider Details

I. General information

NPI: 1407893035
Provider Name (Legal Business Name): PAUL D EDWARDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2561 THIRD AVENUE PEDIATRIC PLASTIC SURGERY/CRANIOFACIAL C
HUNTINGTON WV
02570
US

IV. Provider business mailing address

1589 CAMPBELL DR
HUNTINGTON WV
25705-2915
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-9131
  • Fax:
Mailing address:
  • Phone: 304-525-9131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number209508
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: