Provider Demographics
NPI:1942368725
Name:EDGECOMB, MARY E (DO)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:EDGECOMB
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 23RD ST
Mailing Address - Street 2:SUITE 19
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2880
Mailing Address - Country:US
Mailing Address - Phone:606-325-2221
Mailing Address - Fax:
Practice Address - Street 1:617 23RD ST
Practice Address - Street 2:SUITE 19
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101
Practice Address - Country:US
Practice Address - Phone:606-325-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049007207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology