Provider Demographics
NPI:1801885512
Name:KNIGHTS, EDWIN BROOKE (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:BROOKE
Last Name:KNIGHTS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:321 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3718
Mailing Address - Country:US
Mailing Address - Phone:978-263-1131
Mailing Address - Fax:978-263-1562
Practice Address - Street 1:321 MAIN ST
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3718
Practice Address - Country:US
Practice Address - Phone:978-263-1131
Practice Address - Fax:978-263-1562
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA41857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2067536Medicaid
MAA34266Medicare UPIN
MA2067536Medicaid