Provider Demographics
NPI:1942265061
Name:EDWARDS, PERRIN D (DPM)
Entity type:Individual
Prefix:DR
First Name:PERRIN
Middle Name:D
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-3016
Mailing Address - Country:US
Mailing Address - Phone:518-828-6516
Mailing Address - Fax:518-828-9510
Practice Address - Street 1:751 WARREN ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-3016
Practice Address - Country:US
Practice Address - Phone:518-828-6516
Practice Address - Fax:518-828-9510
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002903213E00000X
FLP00001158213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
32791OtherMVP
NY00558943Medicaid
10000555OtherCDPHP
480007799OtherRAILROAD MEDICARE
13721OtherGHI HMO
P32002OtherBCBS
000405556002OtherBS
6202091OtherGHI PPO
480007799OtherRAILROAD MEDICARE
32791OtherMVP