Provider Demographics
NPI:1992857346
Name:EDWARDS, IRENE ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:ELIZABETH
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LIBBY
Other - Middle Name:
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6406 CARMEL RD STE 309
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8267
Mailing Address - Country:US
Mailing Address - Phone:704-367-9777
Mailing Address - Fax:704-367-0504
Practice Address - Street 1:6406 CARMEL RD STE 309
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8267
Practice Address - Country:US
Practice Address - Phone:704-367-9777
Practice Address - Fax:704-367-0504
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23521207R00000X, 208000000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8930186Medicaid
NC2161868BMedicare PIN
NCD43874Medicare UPIN