Provider Demographics
NPI:1649262015
Name:SHEARBURN, EDWIN WEBSTER III (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:WEBSTER
Last Name:SHEARBURN
Suffix:III
Gender:M
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:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-0907
Mailing Address - Country:US
Mailing Address - Phone:215-453-4995
Mailing Address - Fax:215-453-4646
Practice Address - Street 1:915 LAWN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1551
Practice Address - Country:US
Practice Address - Phone:215-453-3400
Practice Address - Fax:215-453-3410
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016225E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA010058OtherBLUE SHIELD
PA0021717000OtherKEYSTONE HEATH PLANS
PA000647298Medicaid
PA000647298Medicaid
PAB31571Medicare UPIN