Provider Demographics
NPI:1356310106
Name:JONES, EDWARD LESLIE (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LESLIE
Last Name:JONES
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SUSQUEHANNOCK TRL
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:PA
Mailing Address - Zip Code:18810-9701
Mailing Address - Country:US
Mailing Address - Phone:570-423-0008
Mailing Address - Fax:
Practice Address - Street 1:55 SUSQUEHANNOCK TRL
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:PA
Practice Address - Zip Code:18810-9701
Practice Address - Country:US
Practice Address - Phone:570-423-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115759-1207Q00000X
PAMD011609E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACC9269OtherRR MEDICARE GROUP
PA080159964OtherRR MEDICARE PIN
PAGU039830OtherMEDICARE GROUP
PA0009248160001Medicaid
NY00793980Medicaid
E70567Medicare UPIN
PA135851N8YMedicare ID - Type Unspecified
PA0009248160001Medicaid