Provider Demographics
NPI:1659360840
Name:MAREADY, EDWARD EARL JR (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:EARL
Last Name:MAREADY
Suffix:JR
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 1:1028 KINGSTON GROVE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6824
Mailing Address - Country:US
Mailing Address - Phone:336-816-3372
Mailing Address - Fax:
Practice Address - Street 1:570 NEW WAVERLY PL
Practice Address - Street 2:SUITE 210
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7405
Practice Address - Country:US
Practice Address - Phone:919-859-3373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93006207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07754OtherBCBS
P00253744OtherRR MCR
FL272354900Medicaid
P00253744OtherRR MCR
FL07754BMedicare PIN
FL07754OtherBCBS