Provider Demographics
NPI:1386651073
Name:EDWARDS, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:EDWARDS
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 1:40-42 ASBURY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982
Mailing Address - Country:US
Mailing Address - Phone:978-468-4101
Mailing Address - Fax:978-468-7067
Practice Address - Street 1:40-42 ASBURY ST
Practice Address - Street 2:
Practice Address - City:SOUTH HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01982
Practice Address - Country:US
Practice Address - Phone:978-468-4101
Practice Address - Fax:978-468-7067
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0134813Medicaid
MAM21790Medicare ID - Type Unspecified
MA0134813Medicaid