Basic Information
| Provider Information | |||||||||
| NPI: | 1104333582 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDMONDS | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 SPRING HILL LN | ||||||||
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| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197112826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3029851915 | ||||||||
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| Practice Location | |||||||||
| Address1: | 278 EAGLEVIEW BLVD | ||||||||
| Address2: | |||||||||
| City: | EXTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193411157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105616400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2018 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.