Provider Demographics
NPI:1164468682
Name:REDOVAN, EDWARD G (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:G
Last Name:REDOVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:708 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-2178
Mailing Address - Country:US
Mailing Address - Phone:724-658-5597
Mailing Address - Fax:724-658-8364
Practice Address - Street 1:708 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-2178
Practice Address - Country:US
Practice Address - Phone:724-658-5597
Practice Address - Fax:724-658-8364
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030598E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012198860001Medicaid
PA103179Medicare ID - Type Unspecified
PAE52746Medicare UPIN