Basic Information
| Provider Information | |||||||||
| NPI: | 1457372112 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 MORRIS STREET | ||||||||
| Address2: | STE 104 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043431399 | ||||||||
| FaxNumber: | 3043457824 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 MORRIS STREET | ||||||||
| Address2: | STE 104 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043431399 | ||||||||
| FaxNumber: | 3043457824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 05/01/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 19013 | WV | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0660720001 | 01 | CIGNA GOVERNMENT SERVICES | OTHER | 2140608 | 01 | WV | UNITED HCARE | OTHER | 001717676 | 01 | WV | BCBS | OTHER | 0098538000 | 05 | WV | MEDICAID |