Provider Demographics
NPI:1548222979
Name:PAVILLARD, EDWARD K (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:K
Last Name:PAVILLARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W LINFIELD TRAPPE RD
Mailing Address - Street 2:STE 3200
Mailing Address - City:LIMERICK
Mailing Address - State:PA
Mailing Address - Zip Code:19468-4278
Mailing Address - Country:US
Mailing Address - Phone:610-495-2550
Mailing Address - Fax:610-495-2588
Practice Address - Street 1:420 W LINFIELD TRAPPE RD
Practice Address - Street 2:STE 3200
Practice Address - City:LIMERICK
Practice Address - State:PA
Practice Address - Zip Code:19468-4278
Practice Address - Country:US
Practice Address - Phone:610-495-2550
Practice Address - Fax:610-495-2588
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010760L2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA096348Medicare ID - Type Unspecified
I46357Medicare UPIN