1528004900 NPI number — DR. EVELYN PAGE EDMUNDS PH.D.

Table of content: DR. EVELYN PAGE EDMUNDS PH.D. (NPI 1528004900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528004900 NPI number — DR. EVELYN PAGE EDMUNDS PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDMUNDS
Provider First Name:
EVELYN
Provider Middle Name:
PAGE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528004900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 CHATSWORTH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALLSTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21047-1503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-877-7825
Provider Business Mailing Address Fax Number:
410-877-1897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1208 E CHURCHVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
BEL AIR
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21014-3442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-893-1407
Provider Business Practice Location Address Fax Number:
410-877-1897
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  02189 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0 G568 EP 62 . This is a "CAREFIRST PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 221875 . This is a "COMPSYCH PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 100026480001 . This is a "APS PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 002410 . This is a "VALUE OPTIONS PROVIDER #" identifier , issued by the state of ( MH ) . This identifiers is of the category "OTHER".




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