Provider Demographics
NPI:1518956473
Name:COLBY, EDWARD LAWRENCE (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LAWRENCE
Last Name:COLBY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61353 SOUTHGATE RD
Mailing Address - Street 2:SUITE#6
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-6607
Mailing Address - Country:US
Mailing Address - Phone:740-432-3434
Mailing Address - Fax:740-432-3053
Practice Address - Street 1:61353 SOUTHGATE RD
Practice Address - Street 2:SUITE#6
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-6607
Practice Address - Country:US
Practice Address - Phone:740-432-3434
Practice Address - Fax:740-432-3053
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004997207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0879830Medicaid
OHC04997OtherHEALTH PLAN UPPER OHIO VA
OH000000119977OtherANTHEM COMMUNITY MUTUAL
OH110069654 RRMedicare PIN
OHF28323Medicare UPIN
OH000000119977OtherANTHEM COMMUNITY MUTUAL