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Contact Information

MARK T EDGE, PHD MD
620 SUMMIT CROSSING PL
STE 106
GASTONIA, NC28054
 Phone: 704-867-8021
 Fax: 704-864-4606
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Diagnostic Radiology

2085R0202X 30 Physician/Diagnostic Radiology
 

Neuroradiology

2085N0700X
Indicates primary specialty

NPI Profile & details for MARK T EDGE · (Male)

NPI Number 1003899766
Status Active
Credentials PHD MD
Entity Individual
Enumeration date 11/26/2005
Last updated 08/23/2010 - About 16 years ago
Sole proprietor 1 No
Identifiers
  • NC License # 200200890
  • NC Medicaid 89132UH
  • SC Medicaid N0089D
  • Other 3616445 AETNA HMO
  • Other 7436626 AETNA PPO
  • Other 132UH BLUE CROSS BLUE SHIELD
  • Other D4988 MEDCOST
  • Other 801319 PARTNERS
  • Other P00167818 RAILROAD MEDICARE
  • Other 560988142 UNITED HEALTHCARE
Hospital affiliation(s)
  • GASTON MEMORIAL HOSPITAL - (Acute Care)
    2525 COURT DR
    GASTONIA, NC 28052
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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