Provider Demographics
NPI:1346382900
Name:EDMUNDSON, WARNER LEE WELLS (MD)
Entity Type:Individual
Prefix:DR
First Name:WARNER LEE
Middle Name:WELLS
Last Name:EDMUNDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:W. L.
Other - Middle Name:WELLS
Other - Last Name:EDMUNDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 18563
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-8563
Mailing Address - Country:US
Mailing Address - Phone:919-782-1806
Mailing Address - Fax:919-782-1669
Practice Address - Street 1:3521 HAWORTH DRIVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7244
Practice Address - Country:US
Practice Address - Phone:919-782-1806
Practice Address - Fax:919-782-4756
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25490207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8930144Medicaid
2449756OtherCIGNA
A3869OtherMEDCOST
0456749OtherUNITED HEALTHCARE
110221901OtherRAILROAD MEDICARE
110221901OtherRAILROAD MEDICARE
A3869OtherMEDCOST