Provider Demographics
NPI:1659311017
Name:EDWARDS, RICHARD THOMAS III (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:THOMAS
Last Name:EDWARDS
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:4461 STARKEY ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018
Mailing Address - Country:US
Mailing Address - Phone:540-345-4946
Mailing Address - Fax:540-982-7164
Practice Address - Street 1:4461 STARKEY ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018
Practice Address - Country:US
Practice Address - Phone:540-345-8896
Practice Address - Fax:540-343-0722
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101018580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA110127678OtherRAILROAD MEDICARE
VA1659311017Medicaid
VA110127678OtherRAILROAD MEDICARE
010395P45Medicare ID - Type Unspecified