Provider Demographics
NPI:1831202373
Name:HILDREW, EDWARD L (DO)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:L
Last Name:HILDREW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 S 2ND ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 S FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101
Practice Address - Country:US
Practice Address - Phone:717-988-0000
Practice Address - Fax:717-782-5716
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003464L207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001613525Medicaid
PA50032030OtherCAPITAL BC
PA000024197OtherHIGHMARK BS
PA1514916OtherGATEWAY
PA30024130OtherKEYSTONE MERCY
PA13040OtherGEISINGER
PA141300OtherUNISON
PA024197RQJMedicare PIN
PA141300OtherUNISON
PA0016135250008Medicaid
PAP00013563Medicare PIN