Healthcare Provider Details

I. General information

NPI: 1699746354
Provider Name (Legal Business Name): BENJAMIN W EDINGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 06/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 OLD BRANCH AVE SUITE 300
CLINTON MD
20735-1608
US

IV. Provider business mailing address

7801 OLD BRANCH AVE SUITE 300
CLINTON MD
20735-1608
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-6718
  • Fax: 301-856-6722
Mailing address:
  • Phone: 301-856-6718
  • Fax: 301-856-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD61849
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: