MEDICARE: EDWARD JAMES KODY 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	208000000X	Pediatrics Physician	G60423	CA
2	208000000X	Pediatrics Physician	MD452976	PA

General Provider Information

NPI Number	:	1467418178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD JAMES KODY MD

Provider Business Mailing Address
First Line	:	21 SHEEDER MILL RD
Second Line	:
City	:	SPRING CITY
State	:	PA
Zip	:	19475-3406
Country	:	US
Telephone Number	:	209-985-3847
Fax Number	:	209-985-3847

Provider Business Practice Location Address
First Line	:	21 SHEEDER MILL RD
Second Line	:
City	:	SPRING CITY
State	:	PA
Zip	:	19475-3406
Country	:	US
Telephone Number	:	209-985-3847
Fax Number	:	209-985-3847

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

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	10/01/2014

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