Provider Demographics
NPI:1194722298
Name:ROLEY, EDWIN (PA)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:ROLEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-0950
Mailing Address - Country:US
Mailing Address - Phone:828-645-3066
Mailing Address - Fax:828-658-1445
Practice Address - Street 1:63 MONTICELLO RD
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9441
Practice Address - Country:US
Practice Address - Phone:828-645-3066
Practice Address - Fax:828-658-1445
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001-01746363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS63549Medicare UPIN
NC2746168Medicare ID - Type Unspecified
NC0144030001Medicare NSC