Provider Demographics
NPI:1174571939
Name:WILLIAM C EDGERTON
Entity type:Organization
Organization Name:WILLIAM C EDGERTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:EDGERTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-281-2550
Mailing Address - Street 1:9B DR OSMAN BABSON RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-1812
Mailing Address - Country:US
Mailing Address - Phone:978-281-2550
Mailing Address - Fax:
Practice Address - Street 1:9B DR OSMAN BABSON RD
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-1812
Practice Address - Country:US
Practice Address - Phone:978-281-2550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY77232OtherBLUE CROSS/BLUE SHIELD
Y78058Medicare ID - Type Unspecified
MAY70573Medicare PIN