Healthcare Provider Details

I. General information

NPI: 1770955452
Provider Name (Legal Business Name): MARIE EDIAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 L STREET NW 900
WASHINGTON DC
20036
US

IV. Provider business mailing address

9011 3RD STREET
LANHAM MD
20706
US

V. Phone/Fax

Practice location:
  • Phone: 202-829-1111
  • Fax:
Mailing address:
  • Phone: 240-646-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: