Provider Demographics
NPI:1659378297
Name:EDMONDS, DAVID A (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:EDMONDS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-1612
Mailing Address - Country:US
Mailing Address - Phone:610-262-3417
Mailing Address - Fax:610-262-1404
Practice Address - Street 1:1356 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18067-1612
Practice Address - Country:US
Practice Address - Phone:610-262-3417
Practice Address - Fax:610-262-1404
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003440L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA005231OtherHIGHMARK
PA01334201OtherCAPTIAL BLUE CROSS
PA005231G6JMedicare ID - Type Unspecified
PA01334201OtherCAPTIAL BLUE CROSS