Provider Demographics
NPI:1538146121
Name:MEASE, EDWARD C (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:C
Last Name:MEASE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 MARGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-3352
Mailing Address - Country:US
Mailing Address - Phone:954-974-8222
Mailing Address - Fax:954-974-2623
Practice Address - Street 1:7610 MARGATE BLVD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-3352
Practice Address - Country:US
Practice Address - Phone:954-974-8222
Practice Address - Fax:954-974-2623
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31588208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055804400Medicaid
FLD55887Medicare UPIN
FL055804400Medicaid
FL50894Medicare PIN