Provider Demographics
NPI:1508871070
Name:OBEID, EDMOND (MD)
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:
Last Name:OBEID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1605 N CEDAR CREST BLVD STE 110B
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:610-973-1410
Mailing Address - Fax:610-973-1449
Practice Address - Street 1:1720 W. FAIRMOUNT ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104
Practice Address - Country:US
Practice Address - Phone:610-841-2798
Practice Address - Fax:610-841-2796
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429693207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
50062407OtherCBC
PA1017873020001Medicaid
P008401OtherGATEWAY
001902866OtherHIGHMARK BLUE SHIELD
2769924000OtherIBC
20056021OtherAMERIHEALTH MERCY HEALTH
001902866OtherHIGHMARK BLUE SHIELD
50062407OtherCBC