Provider Demographics
NPI:1720405699
Name:EDWARDS, MARTY (ND)
Entity Type:Individual
Prefix:
First Name:MARTY
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 S JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1036
Mailing Address - Country:US
Mailing Address - Phone:215-221-2305
Mailing Address - Fax:
Practice Address - Street 1:529 S JUNIPER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1036
Practice Address - Country:US
Practice Address - Phone:215-221-2305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath