Provider Demographics
NPI:1609915685
Name:EDWARDS, HOWARD BERRYMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:BERRYMAN
Last Name:EDWARDS
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 1:14205 SE 36TH ST
Mailing Address - Street 2:100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1596
Mailing Address - Country:US
Mailing Address - Phone:425-998-6123
Mailing Address - Fax:
Practice Address - Street 1:14205 SE 36TH ST
Practice Address - Street 2:100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1596
Practice Address - Country:US
Practice Address - Phone:425-998-6123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000223872084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA06038Medicare UPIN
WA0106179Medicare ID - Type Unspecified