Provider Demographics
NPI:1720081250
Name:EDWARDS, JAMES TRAVERS JR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:TRAVERS
Last Name:EDWARDS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-594-2195
Practice Address - Street 1:12 BRUTON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1602
Practice Address - Country:US
Practice Address - Phone:757-594-4111
Practice Address - Fax:757-594-4115
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101027348207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1720081250Medicaid
VA017028R53Medicare PIN
VA1720081250Medicaid
VA082947220Medicare PIN