Provider Demographics
NPI:1912955758
Name:EDMANDS, CHRISTOPHER JAMES (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:EDMANDS
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:418 GRAND PARK DR STE 312
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26105-4000
Practice Address - Country:US
Practice Address - Phone:304-422-3435
Practice Address - Fax:304-422-3430
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1952207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2410055Medicaid
WV1841931000Medicaid
WVWV3139AMedicaid
001722069OtherBLUE CROSS/BLUE SHIELD
P00037068OtherRAILROAD MEDICARE
001722069OtherBLUE CROSS/BLUE SHIELD
WVWV3139AMedicaid