Provider Demographics
NPI:1992886097
Name:PICARDI, EDWARD J (MD, FACS)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:PICARDI
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 E MINNESOTA ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7756
Mailing Address - Country:US
Mailing Address - Phone:605-342-5573
Mailing Address - Fax:605-341-2161
Practice Address - Street 1:4000 JOHNSON RD FL 2
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2364
Practice Address - Country:US
Practice Address - Phone:740-266-5956
Practice Address - Fax:740-266-5957
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD2822208600000X
OH35.050753208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7301243Medicaid
SD0005993OtherBLUE CROSS BLUE SHIELD
OH0392398Medicaid
SD0005993OtherBLUE CROSS BLUE SHIELD