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General NPI Number Information
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NPI Number | 1205142155
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Entity Type | Organization
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Legal Business Name | ROXANNE DRYDEN-EDWARDS, MD LLC
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Dates
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Enumeration Date | 08/28/2010
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Last Update Date | 08/28/2010
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Provider Practice Location Address
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Address Line | 9055 SHADY GROVE CT
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City | GAITHERSBURG
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State | MD
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Zip | 20877-1301
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Country | US
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Telephone | 908-625-9713
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Fax |
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Provider Business Mailing Address
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Address Line | 9055 SHADY GROVE CT
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City | GAITHERSBURG
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State | MD
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Zip | 20877-1301
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Country | US
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Telephone | 908-625-9713
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MARK CHRISTOPHER EDWARDS
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Credential |
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Telephone | 908-625-9713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 3127
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 41445
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License Number State | MD
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