Provider Demographics
NPI:1164428140
Name:WRIGHT, EDWARD THORBURN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:THORBURN
Last Name:WRIGHT
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 1:1040 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1816
Mailing Address - Country:US
Mailing Address - Phone:434-792-1433
Mailing Address - Fax:434-797-2807
Practice Address - Street 1:1040 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1816
Practice Address - Country:US
Practice Address - Phone:434-792-1433
Practice Address - Fax:434-797-2807
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-00428208800000X
VA0101248303208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA414539OtherANTHEM
VAP0086324OtherRAILROAD MEDICARE
VA1164428140OtherCIGNA
VA1164428140Medicaid
NC8989321Medicaid
NC2222495CMedicare PIN
VA1164428140OtherCIGNA
NC8989321Medicaid
VAP0086324OtherRAILROAD MEDICARE