Provider Demographics
NPI:1952409344
Name:WASHABAUGH, EDWARD PETER III (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:PETER
Last Name:WASHABAUGH
Suffix:III
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 1:710 AVIS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-9649
Mailing Address - Country:US
Mailing Address - Phone:734-373-7246
Mailing Address - Fax:734-375-6585
Practice Address - Street 1:710 AVIS DR STE 200
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-9649
Practice Address - Country:US
Practice Address - Phone:734-373-7246
Practice Address - Fax:734-375-6585
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055135208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0813415OtherBCBS OF MI PIN
MI5894443OtherAETNA INDIVIDUAL NO
MI1589714OtherUNITED HEALTHCARE NO
0N76360Medicare PIN
MIF54926Medicare UPIN
MIF54926Medicare UPIN