Healthcare Provider Details

I. General information

NPI: 1346464286
Provider Name (Legal Business Name): AUDRA ELAINE FORD MD, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7051 ROCKLEDGE DR
BETHESDA MD
20817-1680
US

IV. Provider business mailing address

5730 EXECUTIVE DR STE 230
CATONSVILLE MD
21228-1762
US

V. Phone/Fax

Practice location:
  • Phone: 301-272-9830
  • Fax:
Mailing address:
  • Phone: 301-572-8340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number210012247
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD98223
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberC149537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: