MEDICARE: MWRDC OF ANNAPOLIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	D0029010	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CK8259	OTHER		RAILROAD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528256633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MWRDC OF ANNAPOLIS

Provider Business Mailing Address
First Line	:	4915 AUBURN AVE
Second Line	:	SUITE 200
City	:	BETHESDA
State	:	MD
Zip	:	20814-2636
Country	:	US
Telephone Number	:	301-907-3939
Fax Number	:	301-656-3943

Provider Business Practice Location Address
First Line	:	1908 FOREST DR
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-4340
Country	:	US
Telephone Number	:	410-897-9854
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWARD DUDEK
Credential	:	M.D.
Telephone Number	:	301-907-3939

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	06/16/2008

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Directions to “MWRDC OF ANNAPOLIS ” Practice Location

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