Healthcare Provider Details

I. General information

NPI: 1396092987
Provider Name (Legal Business Name): CHRISTOPHER DAVID EDENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 SUDLEY RD
MANASSAS VA
20110-4418
US

IV. Provider business mailing address

PO BOX 1430
HARRISONBURG VA
22803-1430
US

V. Phone/Fax

Practice location:
  • Phone: 703-396-5292
  • Fax: 703-396-5297
Mailing address:
  • Phone: 540-564-7084
  • Fax: 540-564-6847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101253519
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101253519
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: