Provider Demographics
NPI:1336203967
Name:EDWARDS, RICHARD ALBERT JR (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALBERT
Last Name:EDWARDS
Suffix:JR
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 1:215 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1649
Mailing Address - Country:US
Mailing Address - Phone:585-344-4700
Mailing Address - Fax:585-345-4191
Practice Address - Street 1:215 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1649
Practice Address - Country:US
Practice Address - Phone:585-344-4700
Practice Address - Fax:585-345-4191
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216110-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00025117002OtherUNIVERA
NY02147804Medicaid
NY060059577OtherRR MEDICARE
NY030441930OtherUNITED HEALTH CARE
NY030441930OtherNORTH AMERICA
NY0298063OtherGHI
NY030441930OtherMAGNA
NY10600580OtherFIDELIS
NYP020216110OtherBLUECROSS BLUESHIELD ROCH
NY030441930OtherCOMMERICAL INSURANCE
NY000526067002OtherBLUECROSS BLUESHIELD WNY
NY105570CKOtherPREFERRED CARE
NY030441930OtherTRICARE
NY030441930OtherAETNA
NY030441930OtherNOVA
NY0711027OtherIHA
NYP010216110OtherBLUE CHOICE