1295994051 NPI number — DR. ARDEN FREDEKING EDWARDS M.D.

Table of content: DR. ARDEN FREDEKING EDWARDS M.D. (NPI 1295994051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295994051 NPI number — DR. ARDEN FREDEKING EDWARDS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDWARDS
Provider First Name:
ARDEN
Provider Middle Name:
FREDEKING
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FREDEKING
Provider Other First Name:
ARDEN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295994051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10401 OLD GEORGETOWN RD
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20814-1911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-530-7700
Provider Business Mailing Address Fax Number:
301-530-7701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10401 OLD GEORGETOWN RD
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20814-1911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-530-7700
Provider Business Practice Location Address Fax Number:
301-530-7701
Provider Enumeration Date:
06/06/2008

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: 207N00000X , with the licence number:  D0076091 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: D0076091 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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