| Edge Medical Care Pc | |
|
5305 Kenilworth Ave Ste 100 Riverdale MD 20737-3110 | |
| (301) 277-7110 | |
| Not Available |
| Full Name | Edge Medical Care Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5305 Kenilworth Ave, Riverdale, Maryland |
| Authorized Official Name and Position | George C Ego-osuala (PRESIDENT) |
| Authorized Official Contact | 3014349147 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edge Medical Care Pc Po Box 7909 Langley Park MD 20787-7909 Ph: () - | Edge Medical Care Pc 5305 Kenilworth Ave Ste 100 Riverdale MD 20737-3110 Ph: (301) 277-7110 |
| NPI Number | 1447255609 |
|---|---|
| Provider Enumeration Date | 06/15/2005 |
| Last Update Date | 07/10/2008 |
| Medicare PECOS PAC ID | 3678644267 |
|---|---|
| Medicare Enrollment ID | O20080625000747 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447255609 | NPI | - | NPPES |
| G02849 | Other | MD | MEDICARE GROUP PTAN |
| 852000300 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | D 47156 (Maryland) | Primary |
| 261QP2300X | Clinic/center - Primary Care | MD 21355 (District Of Columbia) | Secondary |
| Provider Name | George C Ego-osuala |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679578835 PECOS PAC ID: 5799857199 Enrollment ID: I20080630000423 |
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