Healthcare Provider Details

I. General information

NPI: 1457518243
Provider Name (Legal Business Name): EDISA TOKOVIC PADDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8850 COLUMBIA 100 PKWY SUITE 301
COLUMBIA MD
21045-2374
US

IV. Provider business mailing address

7350 VAN DUSEN RD SUITE 130
LAUREL MD
20707-5263
US

V. Phone/Fax

Practice location:
  • Phone: 301-560-4747
  • Fax: 301-776-1725
Mailing address:
  • Phone: 301-560-4747
  • Fax: 301-776-1725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0069167
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: