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General NPI Number Information
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NPI Number | 1700572518
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Entity Type | Organization
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Legal Business Name | MARYLAND PHYSICIANS EDGE LLC
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Dates
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Enumeration Date | 04/14/2023
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 12240 INDIAN CREEK CT STE 130
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City | BELTSVILLE
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State | MD
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Zip | 20705-1260
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Country | US
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Telephone | 301-681-6772
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Fax | 301-681-2773
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Provider Business Mailing Address
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Address Line | 10750 COLUMBIA PIKE STE 700
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City | SILVER SPRING
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State | MD
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Zip | 20901-4461
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Country | US
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Telephone | 301-681-6772
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Fax | 301-681-2773
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | TRACEY M MORAN
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Credential |
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Telephone | 301-681-6772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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