Provider Demographics
NPI:1851387724
Name:CHAMPOUX, EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:CHAMPOUX
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 1:2977 WESTINGHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-8120
Mailing Address - Country:US
Mailing Address - Phone:607-684-6115
Mailing Address - Fax:607-684-6120
Practice Address - Street 1:2977 WESTINGHOUSE RD
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8120
Practice Address - Country:US
Practice Address - Phone:607-684-6115
Practice Address - Fax:607-684-6120
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059883A207RA0201X, 208000000X
NY318518207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics