Provider Demographics
NPI:1518907377
Name:EDGERTON, BETH A (PA)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:EDGERTON
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 7200
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0200
Mailing Address - Country:US
Mailing Address - Phone:252-937-0200
Mailing Address - Fax:252-451-0056
Practice Address - Street 1:91 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-9590
Practice Address - Country:US
Practice Address - Phone:252-937-0235
Practice Address - Fax:252-937-3103
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC103657363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC18845OtherBCBS OF NC
NCP00326702OtherRAILROAD MEDICARE
NCP79656Medicare UPIN