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General NPI Number Information
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NPI Number | 1023102449
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Entity Type | Individual
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Provider Name | VIRGINIA A EDDY MD
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 01/04/2011
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Provider Practice Location Address
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Address Line | 887 CONGRESS ST.
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City | PORTLAND
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State | ME
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Zip | 04102
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Country | US
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Telephone | 207-774-2311
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Fax |
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Provider Business Mailing Address
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Address Line | 301 US ROUTE 1 BUILDING C
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City | SCARBOROUGH
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State | ME
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Zip | 04074-7609
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Country | US
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Telephone | 207-396-8600
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Fax | 207-396-8632
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 015532
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License Number State | ME
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