Provider Demographics
NPI:1124099726
Name:LIM, EDWARD STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:STEPHEN
Last Name:LIM
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 1:144 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3044
Mailing Address - Country:US
Mailing Address - Phone:203-643-0270
Mailing Address - Fax:203-488-1104
Practice Address - Street 1:144 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3044
Practice Address - Country:US
Practice Address - Phone:203-643-0270
Practice Address - Fax:203-488-1104
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033710207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001337105Medicaid
CTD400003711OtherMEDICARE PTAN
CT010033710CT09OtherANTHEM
CT180034796OtherMC
CT001337105Medicaid
CTD400003711OtherMEDICARE PTAN