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Individual
EDWARD G MCKIERNAN IV
Active
Individual
EDWARD G MCKIERNAN IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
004917
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080004917CT04
ANTHEM BCBS PIN
CT
01
—
2V5288
HEALTH NET PIN
CT
01
—
3515548
CIGNA PIN
CT
01
—
3918034
AETNA PIN
CT
01
—
A2983697
OXFORD PIN
CT
Enumeration date
08/31/2006
Last updated
10/14/2010
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