Provider Demographics
NPI:1649598004
Name:EDGERTON, ANNE R (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:R
Last Name:EDGERTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:ELIZABETH
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:830 W HIGH ST STE 360
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-3985
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:830 W HIGH ST STE 360
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3985
Practice Address - Country:US
Practice Address - Phone:419-227-7117
Practice Address - Fax:419-227-2848
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35125280208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0140414Medicaid
OH0140414Medicaid