Provider Demographics
NPI:1962593046
Name:CODY, EDMUND JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:JOSEPH
Last Name:CODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:129 WOODSON ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3255
Mailing Address - Country:US
Mailing Address - Phone:704-636-5576
Mailing Address - Fax:704-636-1755
Practice Address - Street 1:129 WOODSON ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3255
Practice Address - Country:US
Practice Address - Phone:704-636-5576
Practice Address - Fax:704-636-1755
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC96004902080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8923479Medicaid
NCG27932Medicare UPIN