Provider Demographics
NPI:1700848454
Name:EDWARDS, VANCE H (MD)
Entity Type:Individual
Prefix:DR
First Name:VANCE
Middle Name:H
Last Name:EDWARDS
Suffix:
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:PO DRAWER 1757
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27533
Mailing Address - Country:US
Mailing Address - Phone:919-734-1866
Mailing Address - Fax:919-736-1804
Practice Address - Street 1:2700 MEDICAL OFFICE PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9460
Practice Address - Country:US
Practice Address - Phone:919-734-1866
Practice Address - Fax:919-736-1804
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98005222085R0204X, 2085R0202X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02898OtherWORK COMP
NC1226QOtherBCBS NC STATE
NC1226QOtherBCBS
NC891226QMedicaid
NC02898OtherWORK COMP
NC2264433Medicare ID - Type Unspecified