Provider Demographics
NPI:1811931710
Name:WRENN, EDWARD H (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:H
Last Name:WRENN
Suffix:
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 1:3824 NORTHERN PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2141
Mailing Address - Country:US
Mailing Address - Phone:412-457-0060
Mailing Address - Fax:
Practice Address - Street 1:2570 HAYMAKER RD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3513
Practice Address - Country:US
Practice Address - Phone:412-858-7618
Practice Address - Fax:412-858-7628
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-01-17
Deactivation Date:2021-02-19
Deactivation Code:
Reactivation Date:2023-01-17
Provider Licenses
StateLicense IDTaxonomies
PAMD053215L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001481275Medicaid
5818018OtherAETNA
P000145OtherGATEWAY HEALTH PLAN
110139597OtherRAILROAD MEDICARE
537996OtherBLUE SHIELD
101930OtherUPMC HEALTH PLAN
101930OtherUPMC HEALTH PLAN
PA537996Medicare PIN
101930OtherUPMC HEALTH PLAN