Healthcare Provider Details

I. General information

NPI: 1750502845
Provider Name (Legal Business Name): ROXANNE DRYDEN-EDWARDS, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 01/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9055 SHADY GROVE CT
GAITHERSBURG MD
20877-1301
US

IV. Provider business mailing address

9055 SHADY GROVE CT
GAITHERSBURG MD
20877-1301
US

V. Phone/Fax

Practice location:
  • Phone: 301-330-0400
  • Fax: 301-948-4333
Mailing address:
  • Phone: 301-330-0400
  • Fax: 301-948-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROXANNE DRYDEN-EDWARDS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-330-0400