Healthcare Provider Details

I. General information

NPI: 1992659908
Provider Name (Legal Business Name): MARYLAND PHYSICIANS EDGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10750 COLUMBIA PIKE STE 700
SILVER SPRING MD
20901-4461
US

IV. Provider business mailing address

PO BOX 14079
BELFAST ME
04915-4031
US

V. Phone/Fax

Practice location:
  • Phone: 301-681-6772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRACEY M MORAN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 301-681-6772