Basic Information
| Provider Information | |||||||||
| NPI: | 1922248848 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EDGEWOOD PROFESSIONAL SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 ACEE DR | ||||||||
| Address2: | |||||||||
| City: | NATRONA HEIGHTS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150659700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002235544 | ||||||||
| FaxNumber: | 7242943206 | ||||||||
| Practice Location | |||||||||
| Address1: | 239 EDGEWOOD DRIVE EXT | ||||||||
| Address2: | |||||||||
| City: | TRANSFER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161541817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7246460400 | ||||||||
| FaxNumber: | 7246460413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2009 | ||||||||
| LastUpdateDate: | 03/05/2009 | ||||||||
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| AuthorizedOfficialLastName: | GRIFFITH | ||||||||
| AuthorizedOfficialFirstName: | ROB | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 7246460400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.