Individual
EDWARD RE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3401 CIVIC CENTER BLVD, DIVISION OF SPORTS MEDICINE, PHILADELPHIA, PA 19104-4319
(718) 598-0278
Mailing address
2020 WALNUT ST, APT 11J, PHILADELPHIA, PA 19103-5635
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MT210381
PA
2080S0010X
Pediatric Sports Medicine Physician
Primary
MD468533
PA
2080S0010X
Pediatric Sports Medicine Physician
MT210381
PA
Other
Enumeration date
04/29/2016
Last updated
06/29/2021
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