Provider Demographics
NPI:1003812496
Name:BIGOS, EDWARD T (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:T
Last Name:BIGOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2339 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1623
Mailing Address - Country:US
Mailing Address - Phone:610-790-9648
Mailing Address - Fax:888-780-2882
Practice Address - Street 1:1170 BERKSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1215
Practice Address - Country:US
Practice Address - Phone:610-378-0481
Practice Address - Fax:610-378-9762
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD029276E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001129967Medicaid
PA001129967Medicaid
PA108818Medicare PIN