Healthcare Provider Details

I. General information

NPI: 1356321830
Provider Name (Legal Business Name): EDWARD F MORRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 MAPLE AVENUE WEST STE. 5
VLENNA VA
22180
US

IV. Provider business mailing address

410 MAPLE AVENUE WEST STE. 5
VLENNA VA
22180
US

V. Phone/Fax

Practice location:
  • Phone: 703-938-2244
  • Fax: 703-938-3669
Mailing address:
  • Phone: 703-938-2244
  • Fax: 703-938-3669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101055335
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: