Provider Demographics
NPI:1376505313
Name:MCGRATH, EDMUND WILLIAM JR (MD)
Entity type:Individual
Prefix:
First Name:EDMUND
Middle Name:WILLIAM
Last Name:MCGRATH
Suffix:JR
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:PO BOX 25317
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-5317
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:1411 S 14TH ST STE D
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3092
Practice Address - Country:US
Practice Address - Phone:904-321-0064
Practice Address - Fax:904-491-3113
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50062207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036485100Medicaid
FLE75863Medicare UPIN
FL036485100Medicaid