Provider Demographics
NPI:1265471940
Name:EDDE, PETER B (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:B
Last Name:EDDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 KING OF PRUSSIA RD STE 205
Mailing Address - Street 2:
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4557
Mailing Address - Country:US
Mailing Address - Phone:610-902-5600
Mailing Address - Fax:610-902-2304
Practice Address - Street 1:145 KING OF PRUSSIA RD STE 205
Practice Address - Street 2:
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-4557
Practice Address - Country:US
Practice Address - Phone:610-902-5600
Practice Address - Fax:610-902-2304
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD425127207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11534472OtherCAQH ID#
PA30028625OtherKEYSTONE MERCY
PA1012049750002Medicaid
PA1187096OtherAETNA HMO
PA2316955000OtherAMERIHEALTH/INTERCOUNTY
PA7002774OtherAETNA PPO
PA3762098OtherCIGNA HMO/PPO
PA1642688OtherHIGHMARK BLUE SHIELD
PA2316955000OtherIBC - PC/KHPE
PAI22642Medicare UPIN
PAI22642Medicare UPIN