Provider Demographics
NPI:1467415901
Name:OSTROWSKI, EDWARD STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:STEPHEN
Last Name:OSTROWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1207
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30722-1207
Mailing Address - Country:US
Mailing Address - Phone:706-278-9729
Mailing Address - Fax:706-226-9378
Practice Address - Street 1:1502 NORTH THORNTON AVENUE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3064
Practice Address - Country:US
Practice Address - Phone:706-278-9729
Practice Address - Fax:706-226-9378
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA736032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2157519Medicaid
MA000767701Medicare PIN