Provider Demographics
NPI:1316914476
Name:LITZ, EDWARD M (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:M
Last Name:LITZ
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 1:490 CHERRY ST
Mailing Address - Street 2:BUILDING B
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-3304
Mailing Address - Country:US
Mailing Address - Phone:304-327-2475
Mailing Address - Fax:
Practice Address - Street 1:490 CHERRY ST
Practice Address - Street 2:BUILDING B
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3304
Practice Address - Country:US
Practice Address - Phone:304-327-2475
Practice Address - Fax:304-327-1791
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09915207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0098835000Medicaid
WV0098835000Medicaid
8801733Medicare ID - Type Unspecified