Provider Demographics
NPI:1902847916
Name:WASHINGTON, EDWARD
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7810 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-2954
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7810 PROVIDENCE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-2954
Practice Address - Country:US
Practice Address - Phone:704-543-6636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25094207L00000X, 207Q00000X
SC17497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911050Medicaid
SC174974Medicaid
NC1902847916Medicaid
SCP00121320OtherRR MEDICARE
SCSC12654592Medicare PIN
NC202459FMedicare PIN
NC202459UMedicare PIN
C07381Medicare UPIN
SC174974Medicaid
SCC073817772Medicare PIN
NC202459HMedicare PIN
NC5911050Medicaid
NCNCA177AMedicare PIN
NC202459NMedicare PIN
NC202459QMedicare PIN
SCSC1265D237Medicare PIN
SCC073817743Medicare PIN
NC202459JMedicare PIN
NC202459MMedicare PIN
SCC073815042Medicare PIN
SCSC12658068Medicare PIN
NC202459SMedicare PIN
NC202459GMedicare PIN
NC1902847916Medicaid
NC202459PMedicare PIN
NC202459RMedicare PIN
NC202459LMedicare PIN