1457518243 NPI number — DR. EDISA TOKOVIC PADDER MD

Table of content: DR. EDISA TOKOVIC PADDER MD (NPI 1457518243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457518243 NPI number — DR. EDISA TOKOVIC PADDER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PADDER
Provider First Name:
EDISA
Provider Middle Name:
TOKOVIC
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1457518243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7350 VAN DUSEN RD
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20707-5263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-560-4747
Provider Business Mailing Address Fax Number:
301-776-1725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8850 COLUMBIA 100 PKWY
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21045-2374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-560-4747
Provider Business Practice Location Address Fax Number:
301-776-1725
Provider Enumeration Date:
05/20/2008

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: 208000000X , with the licence number:  D0069167 , 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)





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