MEDICARE: EDOMED MEDICAL ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D52900	MD

General Provider Information

NPI Number	:	1154510154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDOMED MEDICAL ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	PO BOX 10907
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20914-0907
Country	:	US
Telephone Number	:	301-324-0078
Fax Number	:

Provider Business Practice Location Address
First Line	:	8700 CENTRAL AVE STE 301
Second Line	:
City	:	LANDOVER
State	:	MD
Zip	:	20785-4853
Country	:	US
Telephone Number	:	301-324-0078
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MUSA MARK MOMOH
Credential	:	MD
Telephone Number	:	301-324-0078

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	03/27/2008

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