Provider Demographics
NPI:1699750521
Name:EDMONSTON, JAMES H (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:EDMONSTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-1016
Mailing Address - Country:US
Mailing Address - Phone:585-593-7911
Mailing Address - Fax:585-593-7913
Practice Address - Street 1:313 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1016
Practice Address - Country:US
Practice Address - Phone:585-593-7911
Practice Address - Fax:585-593-7913
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187816-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00040392401OtherUNIVERA PROVIDER ID
NY000528829001OtherBC/BS PROVIDER ID
NY6100236OtherGHI PROVIDER ID
NY2390047OtherINDEPENDENT HEALTH ID
NY01288173Medicaid
PA0969620Medicaid
NYY037457OtherCHAMPUS PROVIDER ID
PA0969620Medicaid
NY6100236OtherGHI PROVIDER ID
NYJ300000494Medicare PIN