Provider Demographics
NPI:1225244924
Name:ABBOTT, EDWIN W (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:W
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 W CHESTER PIKE
Mailing Address - Street 2:C-2
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-7778
Mailing Address - Country:US
Mailing Address - Phone:610-436-8808
Mailing Address - Fax:610-431-1992
Practice Address - Street 1:1515 W CHESTER PIKE
Practice Address - Street 2:C-2
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-7778
Practice Address - Country:US
Practice Address - Phone:610-436-8808
Practice Address - Fax:610-431-1992
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002749L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB37197Medicare UPIN