Provider Demographics
NPI:1710042072
Name:EDWARDS, TYLER ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:ADAM
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 NH ROUTE 11
Mailing Address - Street 2:FAMILY CARE OF FARMINGTON
Mailing Address - City:FARMINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03835
Mailing Address - Country:US
Mailing Address - Phone:603-755-9801
Mailing Address - Fax:603-755-9806
Practice Address - Street 1:316 NH ROUTE 11
Practice Address - Street 2:FAMILY CARE OF FARMINGTON
Practice Address - City:FARMINGTON
Practice Address - State:NH
Practice Address - Zip Code:03835-3843
Practice Address - Country:US
Practice Address - Phone:603-755-9801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3077668Medicaid
NHBE6950124OtherDEA NUMBER
NH30202056Medicaid
NH11559Medicare UPIN