Provider Demographics
NPI:1437213287
Name:EDGAR, PHILIP A (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:A
Last Name:EDGAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ACADIA STREET
Mailing Address - Street 2:
Mailing Address - City:WOLFVILLE
Mailing Address - State:NOVA SCOTIA
Mailing Address - Zip Code:B4P1K7
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:715 S TAFT AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-3237
Practice Address - Country:US
Practice Address - Phone:419-334-6661
Practice Address - Fax:419-334-6685
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068317E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0169759Medicaid
OHG19495Medicare UPIN
OH0169759Medicaid
OHED0805041Medicare PIN