Provider Demographics
NPI:1447237458
Name:EDWARDS, ROGER (DO)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 N EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3114
Mailing Address - Country:US
Mailing Address - Phone:681-238-5258
Mailing Address - Fax:681-238-5700
Practice Address - Street 1:956 N EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3114
Practice Address - Country:US
Practice Address - Phone:681-238-5258
Practice Address - Fax:681-238-5700
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV993207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0041038000Medicaid
WV001718049OtherWV BCBS
WV1053516OtherWV DWC
WV930125145Medicare PIN
WV001718049OtherWV BCBS
WV4031812Medicare PIN
WV1053516OtherWV DWC
WV930125144Medicare PIN