Provider Demographics
NPI:1053630996
Name:MCDADE, EDWARD DONALD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DONALD
Last Name:MCDADE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19045 LAKE SWATARA DR
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736-7709
Mailing Address - Country:US
Mailing Address - Phone:352-359-7458
Mailing Address - Fax:
Practice Address - Street 1:19045 LAKE SWATARA DR
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32736-7709
Practice Address - Country:US
Practice Address - Phone:352-359-7458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0030354207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55061Medicare UPIN