Healthcare Provider Details

I. General information

NPI: 1649522434
Provider Name (Legal Business Name): EDMUND ABENDONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 DIVISION AVE NE
WASHINGTON DC
20019-5457
US

IV. Provider business mailing address

6927 HEIDELBURG RD
LANHAM MD
20706-4602
US

V. Phone/Fax

Practice location:
  • Phone: 202-291-7226
  • Fax: 202-291-4009
Mailing address:
  • Phone: 202-291-7226
  • Fax: 202-291-4009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: