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NPI Code Detail

MEDICARE: DR. EDWARD JOHN PRIMKA III M.D.

MEDICARE: DR. EDWARD JOHN PRIMKA III 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
1207N00000XDermatology PhysicianMD0000035486TN
2207NS0135XProcedural Dermatology PhysicianMD0000035486TN
3207ND0101XMOHS-Micrographic Surgery PhysicianMD0000035486TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
470015833OTHERSDRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2100035981OTHERTNPHP TNCARE
35533476OTHERTNAETNA
5621247710OTHERSDTRICARE FARRAGUT
6340133OTHERTNUNITED HEALTHCARE
73788990004OTHERTNCIGNA
84015496OTHERTNBLUE CROSS BLUE SHIELD
9621247710001OTHERTNTRICARE ST.MARY'S

General Provider Information

NPI Number : 1134105919
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWARD JOHN PRIMKA III M.D.
Provider Business Mailing Address
First Line : PO BOX 23329
Second Line :
City : NEW YORK
State : NY
Zip : 10087-3329
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1450 DOWELL SPRINGS BLVD STE 210
Second Line :
City : KNOXVILLE
State : TN
Zip : 37909-2448
Country : US
Telephone Number : 865-524-2547
Fax Number : 865-205-5601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2005
Last Update Date : 04/02/2026

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