Provider Demographics
NPI:1861488025
Name:EDWARDS, NORMAN E (MD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:E
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 1:203 S WATER ST
Mailing Address - Street 2:PO BOX 120
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-1387
Mailing Address - Country:US
Mailing Address - Phone:606-638-4504
Mailing Address - Fax:606-638-4186
Practice Address - Street 1:203 S WATER ST
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-1387
Practice Address - Country:US
Practice Address - Phone:606-638-4504
Practice Address - Fax:606-638-4186
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13894207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0055902000OtherMEDICAID
KY64138944Medicaid
WV0055902000OtherMEDICAID
KY1160401Medicare ID - Type Unspecified