Basic Information
| Provider Information | |||||||||
| NPI: | 1033157631 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PASTERNAK | ||||||||
| FirstName: | EDMOND | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 75113 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212755113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044221666 | ||||||||
| FaxNumber: | 9043460113 | ||||||||
| Practice Location | |||||||||
| Address1: | 799 FARSON ST EMERGENCY DEPT | ||||||||
| Address2: | |||||||||
| City: | BELPRE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457141044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404011150 | ||||||||
| FaxNumber: | 7404011155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 01/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 1651 | WV | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 34006231 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.