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NPI Code Detail

MEDICARE: DR. EDWARD W WHITESIDES M.D.

MEDICARE: DR. EDWARD W WHITESIDES M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology PhysicianD98830MD
2174400000XSpecialist36671NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033104344
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWARD W WHITESIDES M.D.
Provider Business Mailing Address
First Line : 1905 GLEN MEADE RD
Second Line :
City : WILMINGTON
State : NC
Zip : 28403-6024
Country : US
Telephone Number : 910-763-6251
Fax Number : 910-763-7408
Provider Business Practice Location Address
First Line : 1905 GLEN MEADE RD
Second Line :
City : WILMINGTON
State : NC
Zip : 28403-6024
Country : US
Telephone Number : 910-763-6251
Fax Number : 910-763-7408
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2005
Last Update Date : 12/05/2023

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