Individual provider Active NPI

Erwood Glenn Edwards Jr., M.D.

  • Pediatric Hematology & Oncology Physician
  • Roanoke, VA
National Provider Identifier
1972547560
Registry record updated Dec 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Hematology & Oncology PhysicianTaxonomy code 2080P0207X
License
0101042726 Issued in VA
Practice address
1906 Belleview Ave SE
Dept of Pediatrics
Roanoke, VA 24014-1838
Phone
(540) 981-7376
NPI assigned
Jun 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Hematology & Oncology Physician 2080P0207X 0101042726 VA Primary

Addresses

Primary practice location

1906 Belleview Ave SE
Dept of Pediatrics
Roanoke, VA 24014-1838

Mailing address

2582 Goose Creek Valley Rd
Montvale, VA 24122-2690

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address eedwards9384@direct.carilionclinic.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101022000507 VA Practitioner - Pediatric MedicinePractitioner - Hematology/Oncology 0446443436 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101042726VAMDPediatric Hematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carilion Medical Center CurrentSince Jul 1, 2010 Accepting new patients
Carilion Medical Center CurrentSince Jul 1, 2010 Accepting new patients
Carilion Medical Center Past Accepting new patients

Locations

2017 Jefferson St SW
Roanoke, VA 24014
Phone (540) 981-7128

1906 Belleview Ave SE
Roanoke, VA 24014
Phone (540) 853-0222

Interoperability endpoints

  • Direct secure messaging: eedwards9384@direct.carilionclinic.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607385600000",
    "number": "1972547560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2582 GOOSE CREEK VALLEY RD",
            "city": "MONTVALE",
            "state": "VA",
            "postal_code": "241222690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1906 BELLEVIEW AVE SE",
            "address_2": "DEPT OF PEDIATRICS",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240141838",
            "telephone_number": "540-981-7376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "ERWOOD",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "VA",
            "license": "0101042726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eedwards9384@direct.carilionclinic.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "eedwards9384@direct.carilionclinic.org",
            "address_1": "1906 Belleview Ave SE",
            "address_2": "Dept of Pediatrics",
            "city": "Roanoke",
            "state": "VA",
            "country_code": "US",
            "postal_code": "240141838",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.