Guy Mitchell Edmondson, M.D.
Individual provider Active NPI Family Medicine Physician · Milford, DE
NPI 1871577288 · NPPES record last updated Feb 20, 2019
Key facts
- NPI
- 1871577288
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- C10004097 (DE)
- Practice address
- 310 Mullet Run
Milford, DE 19963-5371 - Phone
- (302) 424-0600
- Fax
- (302) 422-6214
- NPI assigned
- Nov 30, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C10004097 | DE | MD | Family Medicine Physician |
Interoperability endpoints
- gmedmondson@mmassoc.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | C10004097 | DE | Yes |
Addresses
Primary practice location
310 Mullet Run
Milford, DE 19963-5371
Mailing address
640 S. State Street
Mail Code 3055
Dover, DE 19901-3530
Phone (302) 480-1688
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000985902 | Medicaid | DE | |
| 200108213 | Medicaid | DE |
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- Jessica Anne Eberly
- Melisa Marie Edler
- Loretta I Edmondson
- Stacey Edney
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All providers in Milford, DE · Family Medicine Physician in Delaware
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.