Provider Demographics
NPI:1154667657
Name:JEW, EDWARD WALTER JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:WALTER
Last Name:JEW
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 1:100 ADAMS AVE
Mailing Address - Street 2:APT - 224
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243
Mailing Address - Country:US
Mailing Address - Phone:412-484-3675
Mailing Address - Fax:412-489-3675
Practice Address - Street 1:100 ADAMS AVE
Practice Address - Street 2:APT - 224
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243
Practice Address - Country:US
Practice Address - Phone:412-484-3675
Practice Address - Fax:412-489-3675
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0242126208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery