Provider Demographics
NPI:1508837279
Name:EDINGTON, PHILIP A (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:A
Last Name:EDINGTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1805 N CALIFORNIA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6037
Mailing Address - Country:US
Mailing Address - Phone:209-948-5515
Mailing Address - Fax:209-948-9321
Practice Address - Street 1:1899 W MARCH LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6402
Practice Address - Country:US
Practice Address - Phone:209-623-4700
Practice Address - Fax:209-948-9321
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2020-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG58380207W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G583800Medicaid
CA00G583800Medicaid
CAE89701Medicare UPIN