Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 35-097766 | OH |
N | 208000000X | Pediatrician | 57013970 | OH |
Y | 2080P0204X | Pediatric Emergency Doctor | 35-097766 | OH |
NPI | 1295916864 |
---|---|
Provider Name | Amy Edwards |
First Address | Euclid, OH 44117-1714 |
Second Address | Cleveland, OH 44106-1716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2007 |
Last Update Date | 04/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0058252 | (05) | OH |