Provider Demographics
NPI:1497734479
Name:EDWARDS, HEATHER J (DPM)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:J
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 EASTON RD
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-3029
Mailing Address - Country:US
Mailing Address - Phone:610-746-5553
Mailing Address - Fax:610-746-4887
Practice Address - Street 1:16 EASTON RD
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-3029
Practice Address - Country:US
Practice Address - Phone:610-746-5553
Practice Address - Fax:610-746-4887
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002843L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA480004874OtherPALMETTO GBA
PA01190801OtherCAP BLUE CROSS
PA01190801OtherCAP BLUE CROSS
197671Medicare ID - Type Unspecified