Provider Demographics
NPI:1326193293
Name:EDGER, ROBERT REYNOLDS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:REYNOLDS
Last Name:EDGER
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 1:3122 N. SHERIDAN RD. SUITE 2B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1708
Mailing Address - Country:US
Mailing Address - Phone:312-209-1123
Mailing Address - Fax:312-988-9215
Practice Address - Street 1:3122 N. SHERIDAN RD. SUITE 2B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1708
Practice Address - Country:US
Practice Address - Phone:312-209-1123
Practice Address - Fax:312-988-9215
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360692162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC48851Medicare UPIN
IL767550Medicare ID - Type Unspecified