Provider Demographics
NPI:1487940680
Name:EDWARDS, MARGARET ROSE
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:ROSE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MARGARET
Other - Middle Name:ROSE
Other - Last Name:CRISWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:615 S NEW BALLAS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8221
Mailing Address - Country:US
Mailing Address - Phone:314-251-5834
Mailing Address - Fax:314-251-6272
Practice Address - Street 1:615 S NEW BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8221
Practice Address - Country:US
Practice Address - Phone:314-251-5834
Practice Address - Fax:314-251-6272
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-26
Last Update Date:2011-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011019200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine