Provider Demographics
NPI:1144201278
Name:STANTON, EDWARD SPIRES (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:SPIRES
Last Name:STANTON
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 1:1 ARH LANE
Mailing Address - Street 2:SUITE 202B
Mailing Address - City:LOW MOOR
Mailing Address - State:VA
Mailing Address - Zip Code:24457
Mailing Address - Country:US
Mailing Address - Phone:540-862-7181
Mailing Address - Fax:
Practice Address - Street 1:1 ARH LANE
Practice Address - Street 2:SUITE 202B
Practice Address - City:LOW MOOR
Practice Address - State:VA
Practice Address - Zip Code:24457
Practice Address - Country:US
Practice Address - Phone:540-862-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27858208600000X
GA061521208600000X
VA0101236472208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC79324OtherBLUE CROSS BLUE SHIELD
VA1144201278Medicaid
P00338174OtherRAILROAD MEDICARE
NC8979324Medicaid
VAVV6120AMedicare PIN
P00338174OtherRAILROAD MEDICARE
210655AMedicare PIN
NC8979324Medicaid