Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 20354 | MA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 20354 | VT |
NPI | 1053330258 |
---|---|
Provider Name | Patrick W Edmunds |
First Address | Greenfield, MA 01301 |
Second Address | Greenfield, MA 01301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |