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General NPI Number Information
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NPI Number | 1669637435
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Entity Type | Individual
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Provider Name | EDWARD BENJAMIN RADDEN III M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/22/2008
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | DC VAMC 50 IRVING STREET
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City | WASHINGTON
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State | DC
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Zip | 20042-0001
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Country | US
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Telephone | 202-745-8308
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Fax |
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Provider Business Mailing Address
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Address Line | 6909 LAUREL AVE # 5682
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City | TAKOMA PARK
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State | MD
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Zip | 20912-4462
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Country | US
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Telephone | 410-206-4263
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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 | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | D0066914
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License Number State | MD
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