Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2255 | ME |
Y | 207Q00000X | Family Doctor | 2255 | ME |
N | 207Q00000X | Family Doctor | 239417 | MA |
NPI | 1144333428 |
---|---|
Provider Name | Christopher M Edwards |
First Address | Gardiner, ME 04345-2615 |
Second Address | Gardiner, ME 04345-2615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 28/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1144333428 | (05) | MA |
1144333428 | (05) | ME |
432681899 | (05) | ME |