| Edge Family Medicine Llc | |
|
5305 Kenilworth Ave # 100 Riverdale MD 20737-3101 | |
| (301) 277-7110 | |
| Not Available |
| Full Name | Edge Family Medicine Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 5305 Kenilworth Ave # 100, Riverdale, Maryland |
| Authorized Official Name and Position | Kelechi Ego-osuala (OWNER) |
| Authorized Official Contact | 3016135376 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edge Family Medicine Llc 5305 Kenilworth Ave # 100 Riverdale MD 20737-3101 Ph: (301) 277-7110 | Edge Family Medicine Llc 5305 Kenilworth Ave # 100 Riverdale MD 20737-3101 Ph: (301) 277-7110 |
| NPI Number | 1801517453 |
|---|---|
| Provider Enumeration Date | 09/12/2022 |
| Last Update Date | 09/12/2022 |
| Medicare PECOS PAC ID | 9133598592 |
|---|---|
| Medicare Enrollment ID | O20221207002490 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801517453 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Kelechi Darlington Ego Osuala |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841856499 PECOS PAC ID: 3173850708 Enrollment ID: I20221207002675 |
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