Provider Demographics
NPI:1134176142
Name:EDWARDS, EARL WILBERT (MD)
Entity type:Individual
Prefix:MR
First Name:EARL
Middle Name:WILBERT
Last Name:EDWARDS
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 1:2200 S GEORGE ST
Mailing Address - Street 2:SUITE W-2
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4594
Mailing Address - Country:US
Mailing Address - Phone:717-747-3220
Mailing Address - Fax:717-747-3338
Practice Address - Street 1:2200 S GEORGE ST
Practice Address - Street 2:SUITE W-2
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4594
Practice Address - Country:US
Practice Address - Phone:717-747-3220
Practice Address - Fax:717-747-3338
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427825207QA0505X, 208D00000X
PABE8901060208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH-68139Medicare UPIN
PA0090250Medicare ID - Type Unspecified