Healthcare Provider Details

I. General information

NPI: 1528256633
Provider Name (Legal Business Name): MWRDC OF ANNAPOLIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 FOREST DR
ANNAPOLIS MD
21401-4340
US

IV. Provider business mailing address

4915 AUBURN AVE SUITE 200
BETHESDA MD
20814-2636
US

V. Phone/Fax

Practice location:
  • Phone: 410-897-9854
  • Fax:
Mailing address:
  • Phone: 301-907-3939
  • Fax: 301-656-3943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD0029010
License Number StateMD

VIII. Authorized Official

Name: DR. EDWARD DUDEK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-907-3939