Provider Demographics
NPI:1154358950
Name:EDWARDS, FRANK JOHN (M D)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:JOHN
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4567 CROSSROADS PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3589
Mailing Address - Country:US
Mailing Address - Phone:315-295-2100
Mailing Address - Fax:315-295-2125
Practice Address - Street 1:2 COULTER ROAD
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-1122
Practice Address - Country:US
Practice Address - Phone:315-462-0106
Practice Address - Fax:315-462-3492
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186372207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000916922003OtherBCBS
NY02194714Medicaid
P00452842Medicare PIN
000916922003OtherBCBS
NYJ400006880Medicare PIN
NY02194714Medicaid