Provider Demographics
NPI:1114073269
Name:EDWARDS, LINDA J (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:J
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9700
Mailing Address - Country:US
Mailing Address - Phone:609-268-3011
Mailing Address - Fax:856-164-5723
Practice Address - Street 1:5045 ROUTE 130 SOUTH
Practice Address - Street 2:SUITE I
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08088
Practice Address - Country:US
Practice Address - Phone:856-764-7660
Practice Address - Fax:856-764-5723
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04974700207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5335507Medicaid
NJ148252Medicare ID - Type Unspecified
NJ5335507Medicaid