Provider Demographics
NPI:1154347250
Name:WEST, EDMUND A P (MD)
Entity type:Individual
Prefix:MR
First Name:EDMUND
Middle Name:A P
Last Name:WEST
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 1:56 WHITEHALL AVE
Mailing Address - Street 2:RT 27
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355
Mailing Address - Country:US
Mailing Address - Phone:860-572-8282
Mailing Address - Fax:860-572-7445
Practice Address - Street 1:56 WHITEHALL AVE
Practice Address - Street 2:RT 27
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355
Practice Address - Country:US
Practice Address - Phone:860-572-8282
Practice Address - Fax:860-572-7445
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT015603207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010015603CT02OtherCTBC
119004722OtherRI MC NUMBER
RI47229OtherRIBC
RI47229OtherRIBC
119004722OtherRI MC NUMBER