Provider Demographics
NPI:1184651549
Name:EDWIN W SHEARBURN III
Entity Type:Organization
Organization Name:EDWIN W SHEARBURN III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHEARBURN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:215-257-4866
Mailing Address - Street 1:920 LAWN AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1560
Mailing Address - Country:US
Mailing Address - Phone:215-257-4866
Mailing Address - Fax:215-257-5938
Practice Address - Street 1:920 LAWN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1560
Practice Address - Country:US
Practice Address - Phone:215-257-4866
Practice Address - Fax:215-257-5938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA010058OtherHIGHMARK BLUE SHIELD
PA075503Medicare PIN