Provider Demographics
NPI:1619961067
Name:EDWARDS, NINA K (MD)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:K
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HIGH ST
Mailing Address - Street 2:STE. 401
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7676
Mailing Address - Country:US
Mailing Address - Phone:207-795-5767
Mailing Address - Fax:207-795-2732
Practice Address - Street 1:12 HIGH ST
Practice Address - Street 2:STE. 401
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7676
Practice Address - Country:US
Practice Address - Phone:207-795-5767
Practice Address - Fax:207-795-2732
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME017148208600000X, 208600000X
MINE0812842086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0201310412OtherBCBS INDIVIDUAL PIN
MI1730346OtherPHYSICIAN HEALTH PLAN PIN
MIDA4938Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP
MI020A310890OtherBCBS GROUP
MI383689447051OtherCOMMUNITY CHOICE MICHIGAN
MIN80150002Medicare PIN
MI7506492OtherAETNA PIN
MI0N80150Medicare ID - Type UnspecifiedMEDICARE GROUP
MI0131041OtherBLUECARE NETWORK
MIH81543Medicare UPIN
MI4548672Medicaid
MIP00064789Medicare PIN