Provider Demographics
NPI:1831160142
Name:ESTRIN, EDWARD
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:ESTRIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3572 BRODHEAD RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-3101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 DUTCH RIDGE RD
Practice Address - Street 2:SUITE C
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-9727
Practice Address - Country:US
Practice Address - Phone:724-773-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044145E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001230103Medicaid
WV3810003861Medicaid
OH0191895Medicaid
PA0012301030007Medicaid
OHP00348346Medicare PIN
PA0012301030007Medicaid
PA300016654Medicare PIN
PA001230103Medicaid
OH0191895Medicaid
WV3810003861Medicaid