Healthcare Provider Details

I. General information

NPI: 1821082801
Provider Name (Legal Business Name): EDWIN RADER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CORTLAND ACRES LANE
THOMAS WV
26292-9704
US

IV. Provider business mailing address

PO BOX 35
NEWBURG WV
26410-0035
US

V. Phone/Fax

Practice location:
  • Phone: 304-463-3331
  • Fax: 304-463-3338
Mailing address:
  • Phone: 304-892-2828
  • Fax: 304-892-2927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15058
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: