Provider Demographics
NPI:1871565762
Name:BARKSDALE, EDWARD M JR (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:M
Last Name:BARKSDALE
Suffix:JR
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-844-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053529L174400000X
OH35-0901952086S0120X
IL036.1715462086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001943914Medicaid
OH0986241Medicaid
PA0014799000009Medicaid
OH749092OtherBUCKEYE
OH000000225713OtherUNISON
OH000000527692OtherANTHEM
OH4510236OtherAETNA
OH0986241OtherBCMH
OH414644OtherWELLCARE
OHBA4213142Medicare PIN
OH4510236OtherAETNA
PAE77291Medicare UPIN
PA0014799000009Medicaid