MEDICARE: PETER B. EDDE MD

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
1	207Q00000X	Family Medicine Physician	MD425127	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11534472	OTHER	PA	CAQH ID#
2	30028625	OTHER	PA	KEYSTONE MERCY
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1187096	OTHER	PA	AETNA HMO
5	2316955000	OTHER	PA	AMERIHEALTH/INTERCOUNTY
6	7002774	OTHER	PA	AETNA PPO
7	3762098	OTHER	PA	CIGNA HMO/PPO
8	1642688	OTHER	PA	HIGHMARK BLUE SHIELD
9	2316955000	OTHER	PA	IBC - PC/KHPE

General Provider Information

NPI Number	:	1265471940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER B. EDDE MD

Provider Business Mailing Address
First Line	:	145 KING OF PRUSSIA RD STE 205
Second Line	:
City	:	RADNOR
State	:	PA
Zip	:	19087-4557
Country	:	US
Telephone Number	:	610-902-5600
Fax Number	:	610-902-2304

Provider Business Practice Location Address
First Line	:	145 KING OF PRUSSIA RD STE 205
Second Line	:
City	:	RADNOR
State	:	PA
Zip	:	19087-4557
Country	:	US
Telephone Number	:	610-902-5600
Fax Number	:	610-902-2304

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	02/27/2023

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Directions to “ PETER B. EDDE MD” Practice Location

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