Basic Information
| Provider Information | |||||||||
| NPI: | 1710177936 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDWARDS | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9746 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041045040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077913888 | ||||||||
| FaxNumber: | 2078287850 | ||||||||
| Practice Location | |||||||||
| Address1: | 153 US ROUTE 1 | ||||||||
| Address2: | |||||||||
| City: | SCARBOROUGH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040749052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077998596 | ||||||||
| FaxNumber: | 2077991730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2007 | ||||||||
| LastUpdateDate: | 09/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204D00000X | 2119 | ME | N | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM | 207Q00000X | 2119 | ME | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.