Provider Demographics
NPI:1023085008
Name:LASHLEY, EDWIN RAY (IDC)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:RAY
Last Name:LASHLEY
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 PULASKI ST
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-6153
Mailing Address - Country:US
Mailing Address - Phone:843-209-6949
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL
Practice Address - Street 2:3600 RIVERS AVE
Practice Address - City:N. CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405
Practice Address - Country:US
Practice Address - Phone:843-743-7214
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman