Provider Demographics
NPI:1740215771
Name:EDWARDS, THOMAS BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BERNARD
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 1:369 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6803
Mailing Address - Country:US
Mailing Address - Phone:413-443-4826
Mailing Address - Fax:413-443-4488
Practice Address - Street 1:369 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6803
Practice Address - Country:US
Practice Address - Phone:413-443-4826
Practice Address - Fax:413-443-4488
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156926207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA158837OtherTUFTS HEALTH PLAN
MA3178781Medicaid
MA3178781Medicaid
MAA23727Medicare PIN