Provider Demographics
NPI:1346313780
Name:CHAIRMAN, EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:CHAIRMAN
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 1:1800 LOMBARD ST
Mailing Address - Street 2:PEPPER 604
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-8400
Mailing Address - Country:US
Mailing Address - Phone:215-732-0200
Mailing Address - Fax:215-732-0200
Practice Address - Street 1:1800 LOMBARD ST
Practice Address - Street 2:PEPPER 604
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-8400
Practice Address - Country:US
Practice Address - Phone:215-732-0200
Practice Address - Fax:215-732-0200
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001337-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005008680001Medicaid
PA004609Medicare UPIN
PAT27571Medicare UPIN