=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174663967
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORMAN R EDWARDS MD LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 THIMBLE SHOALS BLVD #404
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23606-2526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-873-0712
-----------------------------------------------------
Fax | 757-873-0691
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6694
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23606-0694
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-874-0712
-----------------------------------------------------
Fax | 757-874-0691
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | NORMAN ROSS EDWARDS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 757-873-0712
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------