Provider Demographics
NPI:1083620785
Name:GINSBURG, EDO (MD)
Entity Type:Individual
Prefix:
First Name:EDO
Middle Name:
Last Name:GINSBURG
Suffix:
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 1:2450 W. HUNTING PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129
Mailing Address - Country:US
Mailing Address - Phone:215-707-3326
Mailing Address - Fax:215-707-8028
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-3326
Practice Address - Fax:215-707-8028
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060982L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30563OtherHEALTH PARTNERS FRANKFORD
PA0016801070010Medicaid
PA30567OtherHEALTH PARTNERS BUCKS
PA524339OtherHIGHMARK BLUE SHIELD
PA0016801070011Medicaid
PA0474519000OtherKEYSTONE IBC
PA3056444OtherAETNA CONTRACT
PA524339OtherPERSONAL CHOICE
PA01697OtherHEALTH PARTNERS TORRES.
PA30002949OtherKEYSTONE MERCY
PA0016801070011Medicaid
PA0016801070010Medicaid