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General NPI Number Information
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NPI Number | 1023544475
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Entity Type | Individual
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Provider Name | PRESTON JEROME EDGE MD
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Gender | Male
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Dates
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Enumeration Date | 05/04/2017
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 4199 GATEWAY BLVD STE 3500
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City | NEWBURGH
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State | IN
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Zip | 47630-7909
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Country | US
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Telephone | 812-858-5950
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Fax |
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Provider Business Mailing Address
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Address Line | 6201 GREENLEIGH AVE
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City | BALTIMORE
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State | MD
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Zip | 21220-2004
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Country | US
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Telephone | 410-933-6423
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Fax |
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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 | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | 01093233A
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License Number State | IN
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