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General NPI Number Information
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NPI Number | 1548269285
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Entity Type | Individual
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Provider Name | JEREMY VAUGHAN EDWARDS D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 05/02/2020
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Provider Practice Location Address
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Address Line | 4494 NORTH PALMER ROAD DEPARTMENT OF PEDIATRICS
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City | BETHESDA
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State | MD
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Zip | 20889-5001
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Country | US
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Telephone | 301-400-3327
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Fax |
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Provider Business Mailing Address
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Address Line | 21320 RIDGECROFT DR
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City | BROOKEVILLE
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State | MD
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Zip | 20833-1818
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Country | US
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Telephone | 808-233-9121
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | DOS951
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | DOS951
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 2080H0002X
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Taxonomy Name | Pediatric Hospice and Palliative Medicine Physician
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License Number | DOS951
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License Number State | HI
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