Healthcare Provider Details

I. General information

NPI: 1093680746
Provider Name (Legal Business Name): EDWARD GORSUCH KIMBLE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8908 RIGGS RD
ADELPHI MD
20783-1632
US

IV. Provider business mailing address

5 CUMBERLAND CT
ANNAPOLIS MD
21401-1605
US

V. Phone/Fax

Practice location:
  • Phone: 301-431-5630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number36298
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: