Healthcare Provider Details

I. General information

NPI: 1316419179
Provider Name (Legal Business Name): NICHOLAS EDLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 LITTLE PATUXENT PKWY STE 240
COLUMBIA MD
21044-3518
US

IV. Provider business mailing address

5931 CEDAR FERN CT
COLUMBIA MD
21044-3697
US

V. Phone/Fax

Practice location:
  • Phone: 443-276-7627
  • Fax:
Mailing address:
  • Phone: 301-337-9440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR206142
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: