Provider Demographics
NPI:1750515987
Name:BARTLETT, EDWARD WAYLAND (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:WAYLAND
Last Name:BARTLETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:254 W 123RD ST
Mailing Address - Street 2:3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-5428
Mailing Address - Country:US
Mailing Address - Phone:646-657-0247
Mailing Address - Fax:646-657-0247
Practice Address - Street 1:254 W 123RD ST
Practice Address - Street 2:3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-5428
Practice Address - Country:US
Practice Address - Phone:646-657-0247
Practice Address - Fax:646-657-0247
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2528482084P0800X
VT042-00064922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry