Provider Demographics
NPI:1053359331
Name:EDGERTON, WILLIAM C (DPM)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:EDGERTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9B DR OSMAN BABSON RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-1812
Mailing Address - Country:US
Mailing Address - Phone:978-281-2550
Mailing Address - Fax:
Practice Address - Street 1:9B DR OSMAN BABSON RD
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-1812
Practice Address - Country:US
Practice Address - Phone:978-281-8171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1430213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0014003OtherNEIGHBORHOOD HEALTH PLAN
MA2700395OtherEVERCARE
480909147OtherRAILROAD MEDICARE
MA0476472OtherAETNA/US HEALTHCARE
MA6081562002OtherCIGNA
MA0325333Medicaid
MA714064OtherTUFTS HEALTH PLAN
MAT58663OtherHARVARD PILGRIM HEALTHCAR
NYP6691OtherEMPIRE BC/BS
MA714064OtherTUFTS HEALTH PLAN
MA0476472OtherAETNA/US HEALTHCARE