Individual
MARK THOMAS EDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD MD
Contact information
Practice address
620 SUMMIT CROSSING PL, STE 106, GASTONIA, NC 28054
(704) 867-8021
(704) 864-4606
Mailing address
620 SUMMIT CROSSING PL, STE 106, GASTONIA, NC 28054
(704) 867-8021
(704) 864-4606
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
200200890
NC
2085R0202X
Diagnostic Radiology Physician
Primary
200200890
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
132UH
BLUE CROSS BLUE SHIELD
—
01
—
3616445
AETNA HMO
—
01
—
560988142
UNITED HEALTHCARE
—
01
—
7436626
AETNA PPO
—
01
—
801319
PARTNERS
—
05
—
89132UH
—
NC
01
—
D4988
MEDCOST
—
05
—
N0089D
—
SC
01
—
P00167818
RAILROAD MEDICARE
—
Enumeration date
11/26/2005
Last updated
08/23/2010
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