Provider Demographics
NPI:1679155220
Name:EDGAR, WILLIAM SAUNDERS (ATC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SAUNDERS
Last Name:EDGAR
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 KARYNEL DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6417
Mailing Address - Country:US
Mailing Address - Phone:203-962-3084
Mailing Address - Fax:
Practice Address - Street 1:18 KARYNEL DR
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6417
Practice Address - Country:US
Practice Address - Phone:203-962-3084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer