Provider Demographics
NPI:1215916234
Name:EDWARDS, MICHAEL R (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:EDWARDS
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 1:45 ACORN DR
Mailing Address - Street 2:
Mailing Address - City:GOFFSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03045-2942
Mailing Address - Country:US
Mailing Address - Phone:302-598-8359
Mailing Address - Fax:603-663-6645
Practice Address - Street 1:100 MCGREGOR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3730
Practice Address - Country:US
Practice Address - Phone:603-663-6478
Practice Address - Fax:603-663-6645
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006234207P00000X
NH13663207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE001111901Medicaid
NH30208364Medicaid
NH1215916234OtherANTHEM BCBS NH
NH1215916234OtherTRICARE
NH1215916234OtherANTHEM BCBS NH
DE007239S72Medicare ID - Type Unspecified
DE001111901Medicaid