Provider Demographics
NPI:1295716660
Name:EDWARDS, JON H (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:H
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:23625 COMMERCE PARK
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-255-5701
Mailing Address - Fax:216-255-5701
Practice Address - Street 1:771 WEST END AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5572
Practice Address - Country:US
Practice Address - Phone:216-255-5700
Practice Address - Fax:216-255-5701
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1302772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00729680Medicaid
SD7201480Medicaid
ID807444100Medicaid
AZ124078Medicaid
OH2650215Medicaid
NY784T9OtherBCBS
34195845144193OtherTRICARE WEST
NYP00285375OtherRXR MEDICARE
OH2650215Medicaid
ID807444100Medicaid
SD7201480Medicaid