Provider Demographics
NPI:1144333428
Name:EDWARDS, CHRISTOPHER M (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 DRESDEN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-2615
Mailing Address - Country:US
Mailing Address - Phone:207-582-6608
Mailing Address - Fax:207-582-2258
Practice Address - Street 1:152 DRESDEN AVE
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-2615
Practice Address - Country:US
Practice Address - Phone:207-582-6608
Practice Address - Fax:207-582-2258
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239417207Q00000X
ME2255207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1144333428Medicaid
MA1144333428Medicaid
ME432681899Medicaid
1193501Medicare PIN
ME432681899Medicaid