Provider Demographics
NPI:1225181365
Name:HARSHMAN, EDWARD JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JAY
Last Name:HARSHMAN
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 1:33 BOOKER ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:ME
Mailing Address - Zip Code:04861-3821
Mailing Address - Country:US
Mailing Address - Phone:207-354-3545
Mailing Address - Fax:
Practice Address - Street 1:33 BOOKER ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:ME
Practice Address - Zip Code:04861-3821
Practice Address - Country:US
Practice Address - Phone:207-354-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016792207Q00000X, 208100000X
FLME82020207Q00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEHA-ME1768Medicare ID - Type UnspecifiedMEDICARE ID
NY78D43-1Medicare ID - Type UnspecifiedMEDICARE (EXPIRED)
FLA64278Medicare UPIN