Provider Demographics
NPI:1427078336
Name:EDNIE, BRENT (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:EDNIE
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 1:532 W PITTSBURGH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2239
Mailing Address - Country:US
Mailing Address - Phone:724-850-6957
Mailing Address - Fax:724-830-8613
Practice Address - Street 1:532 W PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2239
Practice Address - Country:US
Practice Address - Phone:724-850-6957
Practice Address - Fax:724-830-8613
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054258L207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008400760006Medicaid
PAG22416Medicare UPIN
PA840076Medicare ID - Type Unspecified