Provider Demographics
NPI:1649243361
Name:OPPENHEIMER, EDGAR Y (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:Y
Last Name:OPPENHEIMER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:57 HIGHLAND AVE
Practice Address - Street 2:NO SHORE CHILDRENS HOSPITAL
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2141
Practice Address - Country:US
Practice Address - Phone:978-741-1215
Practice Address - Fax:978-740-4748
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2018-01-22
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Provider Licenses
StateLicense IDTaxonomies
MA37032208000000X, 2084N0400X
NH2612084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C66036Medicare UPIN