Healthcare Provider Details

I. General information

NPI: 1669637435
Provider Name (Legal Business Name): EDWARD BENJAMIN RADDEN III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DC VAMC 50 IRVING STREET
WASHINGTON DC
20042-0001
US

IV. Provider business mailing address

6909 LAUREL AVE # 5682
TAKOMA PARK MD
20912-4462
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8308
  • Fax:
Mailing address:
  • Phone: 410-206-4263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberD0066914
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: