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1679506091

NPI Code Detail

MEDICARE: TERENCE SHAUN EDGAR MD

MEDICARE: TERENCE SHAUN EDGAR 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	34917-20	WI
2	2084E0001X	Epilepsy Physician	34917-20	WI
3	2084N0008X	Neuromuscular Medicine (Psychiatry & Neurology) Physician	34917-20	WI
4	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	34917-20	WI

Other Identifiers

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

General Provider Information

NPI Number	:	1679506091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERENCE SHAUN EDGAR MD

Provider Business Mailing Address
First Line	:	PO BOX 19070
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54307-9070
Country	:	US
Telephone Number	:	920-496-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1821 S WEBSTER AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54301-2253
Country	:	US
Telephone Number	:	920-496-4700
Fax Number	:

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	08/28/2025

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Directions to “ TERENCE SHAUN EDGAR MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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