Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 19784 | SC |
Y | 208000000X | Pediatrician | 9701743 | NC |
NPI | 1003831736 |
---|---|
Provider Name | Martha Edwards |
First Address | Charlotte, NC 28219-9305 |
Second Address | Rock Hill, SC 29732-2084 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 27/09/2021 |