Basic Information
| Provider Information | |||||||||
| NPI: | 1720073943 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARTLETT | ||||||||
| FirstName: | EDWIN | ||||||||
| MiddleName: | CLARY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 810 W H SMITH BLVD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278343763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527572663 | ||||||||
| FaxNumber: | 2523170829 | ||||||||
| Practice Location | |||||||||
| Address1: | 810 W H SMITH BLVD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278343763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527572663 | ||||||||
| FaxNumber: | 2523170829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2005 | ||||||||
| LastUpdateDate: | 03/12/2008 | ||||||||
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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 | 25553 | NC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1274070001 | 01 | DME MAC JURISDICTION C | OTHER | 8913598 | 05 | NC | MEDICAID |