Provider Demographics
NPI:1568833515
Name:EDWIN C FINCH PHD
Entity Type:Organization
Organization Name:EDWIN C FINCH PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:STABLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-327-1414
Mailing Address - Street 1:454 PINE ST
Mailing Address - Street 2:SUITE #2A
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-6200
Mailing Address - Country:US
Mailing Address - Phone:570-327-1414
Mailing Address - Fax:570-327-1616
Practice Address - Street 1:454 PINE ST
Practice Address - Street 2:SUITE #2A
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6200
Practice Address - Country:US
Practice Address - Phone:570-327-1414
Practice Address - Fax:570-327-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005718L305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014074740011Medicaid
PA0014074740011Medicaid