Healthcare Provider Details

I. General information

NPI: 1760571491
Provider Name (Legal Business Name): CHERYL F EDMONDS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 MASSACHUSETTS AVE NW SUITE 217
WASHINGTON DC
20016-4300
US

IV. Provider business mailing address

4910 MASSACHUSETTS AVE NW SUITE 217
WASHINGTON DC
20016-4300
US

V. Phone/Fax

Practice location:
  • Phone: 202-244-1553
  • Fax: 202-244-2192
Mailing address:
  • Phone: 202-244-1553
  • Fax: 202-244-2192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD14258
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: