Provider Demographics
NPI:1588773543
Name:EDWARDS, LENA D (MD)
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:D
Last Name:EDWARDS
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:PO BOX 4305
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BCH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-4305
Mailing Address - Country:US
Mailing Address - Phone:561-257-2968
Mailing Address - Fax:561-771-4196
Practice Address - Street 1:4800 N FEDERAL HWY
Practice Address - Street 2:SUITE B103
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5188
Practice Address - Country:US
Practice Address - Phone:561-257-2968
Practice Address - Fax:561-771-4196
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33162207R00000X
FLME115415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64-331622Medicaid
KYH04133Medicare UPIN