Provider Demographics
NPI:1659483709
Name:JEW, EDWARD WALTER III (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:WALTER
Last Name:JEW
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:575 COAL VALLEY RD
Mailing Address - Street 2:STE 502
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3729
Mailing Address - Country:US
Mailing Address - Phone:412-267-6307
Mailing Address - Fax:412-267-6309
Practice Address - Street 1:575 COAL VALLEY ROAD
Practice Address - Street 2:STE 502 SHMB
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3725
Practice Address - Country:US
Practice Address - Phone:412-267-6307
Practice Address - Fax:412-267-6309
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD038862E207R00000X
PAMD-038862-E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011862010004Medicaid
E12914Medicare UPIN
PA0011862010004Medicaid