Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 15798 | SC |
NPI | 1124012091 |
---|---|
Provider Name | Thomas Arthur Edgerton |
First Address | Boston, MA 02284-3257 |
Second Address | Pinehurst, NC 28374-8710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 13/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C83626 | (02) | SC |
N26227 | (05) | SC |
P00344747 | RAILROAD MEDICARE (01) |