Provider Demographics
NPI:1366550196
Name:EDMONDS, BEATRIX K (MD)
Entity type:Individual
Prefix:
First Name:BEATRIX
Middle Name:K
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:1157 FIRST COLONIAL RD STE 300
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2432
Practice Address - Country:US
Practice Address - Phone:757-333-8001
Practice Address - Fax:757-333-8002
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052205207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC04588OtherMEDICARE GROUP NUMBER
VACK5559OtherRAILROAD MEDICARE
VA005901901Medicaid
VA005901901Medicaid
VACK5559OtherRAILROAD MEDICARE