Provider Demographics
NPI:1194749770
Name:JANUS, EDWARD E (DO)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:E
Last Name:JANUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3123 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-3848
Mailing Address - Country:US
Mailing Address - Phone:814-836-9478
Mailing Address - Fax:814-836-8570
Practice Address - Street 1:3123 W 12TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-3848
Practice Address - Country:US
Practice Address - Phone:814-836-9478
Practice Address - Fax:814-836-8570
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003666L207Q00000X, 207R00000X, 207RC0200X, 207RG0100X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Not Answered207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA74715Medicaid
PA185772Medicaid
PA64972Medicaid
PA049547OtherHIGHMARK FAMILY&INTERNAL
PA155828OtherHEATH AMERICA/ASSURANCE
PA585502OtherAETNA
PA0006234380003Medicaid
PA0006234380005Medicaid
PA10929269OtherUNITED HEALTH CARE
PA961448OtherHIGHMARK INTERNAL MED
PA0006234380003Medicaid
PA0006234380005Medicaid