Provider Demographics
NPI:1952407108
Name:O'DELL, EDWARD ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ROBERT
Last Name:O'DELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:EDWARD
Other - Middle Name:ROBERT
Other - Last Name:O'DELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:101 STEEPLE CHASE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-1545
Mailing Address - Country:US
Mailing Address - Phone:610-656-8791
Mailing Address - Fax:610-903-0637
Practice Address - Street 1:625 N POTTSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1628
Practice Address - Country:US
Practice Address - Phone:610-903-0640
Practice Address - Fax:610-903-0637
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011174L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH85762Medicare UPIN