Provider Demographics
NPI:1811991664
Name:EDWARDS, ROBERT MALCOLM (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MALCOLM
Last Name:EDWARDS
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 1:1240 COLONIAL COMMONS CT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-2200
Mailing Address - Country:US
Mailing Address - Phone:803-285-4333
Mailing Address - Fax:803-285-3472
Practice Address - Street 1:1240 COLONIAL COMMONS CT
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2200
Practice Address - Country:US
Practice Address - Phone:803-285-4333
Practice Address - Fax:803-285-3472
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC13885174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA3870Medicaid
SCD47065Medicare UPIN
SCPA3870Medicaid