Provider Demographics
NPI:1164424131
Name:EDWARDS, DANA PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:PHILLIP
Last Name:EDWARDS
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 1:204 TOWN BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-1322
Mailing Address - Country:US
Mailing Address - Phone:606-598-8766
Mailing Address - Fax:606-598-1903
Practice Address - Street 1:204 TOWN BRANCH RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-1322
Practice Address - Country:US
Practice Address - Phone:606-598-8766
Practice Address - Fax:606-598-1903
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-04-26
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
KY34747208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64347479Medicaid
KY1164424131OtherNPI
KYE82290Medicare UPIN
KY64347479Medicaid