| Doctor Name: | DR. MICAH BOAZ EDWIN |
| NPI Number: | 1033430327 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 2010-01073 |
| Business Practice Address: | 3721 Lynn Rd Suite 104 Raleigh, NC - 276133854 |
| Business Phone Number: | 9102585480 |
| Business Fax Number: | |
| Mailing Address: | 3500 Mill Tree Rd, Apt B4 RALEIGH |
| State: | NC |
| Postal Code: | 276124270 |
| Phone Number: | 5263052802 |
| Fax Number: | |
| NPI Enumeration Date: | 06/21/2010 |
| NPI Last Update Date: | 06/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 2010-01073 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |