Provider Demographics
NPI:1457352353
Name:MCDOWELL, EDWARD L (PA-C)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:L
Last Name:MCDOWELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-2227
Mailing Address - Country:US
Mailing Address - Phone:336-648-8154
Mailing Address - Fax:336-648-8157
Practice Address - Street 1:1201 W LEBANON ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2227
Practice Address - Country:US
Practice Address - Phone:336-648-8154
Practice Address - Fax:336-648-8157
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101127363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP01111980OtherRAILROAD MEDICARE
VA371194700OtherBLACK LUNG
NC1457352353Medicaid
VA540506332094OtherTRICARE
VA1457320353OtherINTOTAL
VA371194700OtherBLACK LUNG
VAP01111980OtherRAILROAD MEDICARE
VA1457352353OtherANTHEM MEDIGAP
VA540506332094OtherTRICARE
VA1457352353OtherMEDICAID QMB
VA1457352353OtherOPTIMA HEALTH PLAN
VAVV4710AMedicare PIN
VA371194700OtherBLACK LUNG