Provider Demographics
NPI:1275665564
Name:COSS, EDWARD WILLIAM JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:WILLIAM
Last Name:COSS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:196 PARKWAY S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-1234
Mailing Address - Country:US
Mailing Address - Phone:860-443-1111
Mailing Address - Fax:860-443-7090
Practice Address - Street 1:196 PARKWAY S
Practice Address - Street 2:SUITE 201
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-1234
Practice Address - Country:US
Practice Address - Phone:860-443-1111
Practice Address - Fax:860-443-7090
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2012-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT195842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT163373OtherMHN
CT0V8993OtherHEALTHNET
CT111210OtherANTHEM
CT001195841Medicaid
CT010019584CT01OtherBLUE CROSS BLUE SHIELD
CT163373OtherMHN
CT260000617Medicare ID - Type Unspecified