Provider Demographics
NPI:1881699916
Name:DEVELIN, EDWARD DUNHAM (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:DUNHAM
Last Name:DEVELIN
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 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:1790 OLD TRAIL RD
Practice Address - Street 2:
Practice Address - City:ETTERS
Practice Address - State:PA
Practice Address - Zip Code:17319-9652
Practice Address - Country:US
Practice Address - Phone:717-938-6588
Practice Address - Fax:717-938-9601
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045320E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA681879OtherHIGHMARK BLUE SHIELD
PA210495OtherJOHNS HOPKINS
PA50079481OtherCAPITAL BLUE CROSS-WMG-WRC
PA50083183OtherCAPITAL BLUE CROSS-WMG WFM
PA55112OtherGEISINGER
MD900422OtherCAREFIRST MD BCBS
PAP000255OtherGATEWAY-WMG
MD001255176Medicaid
PA4406171OtherAETNA
PA50069138OtherCAPITAL BLUE CROSS-WMG
PA245599OtherUNISON-WMG-WRC
PA20062835OtherAMERIHEALTH MERCY-WMG
PA212630OtherUNISON-WMG
PA2168529OtherMAMSI-WMG
PA261034OtherUNISON-WMG WFM
PA4406171OtherAETNA
PAP000255OtherGATEWAY-WMG
PAP00411163Medicare PIN