MEDICARE: DR. ALLISON REGINA EDWARDS

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	D0032051	MD
2	207RC0000X	Cardiovascular Disease Physician	D0032051	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3252AR11	OTHER	MD	BCBS
4	2183	OTHER	DC	BCBS

General Provider Information

NPI Number	:	1194821470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLISON REGINA EDWARDS

Provider Business Mailing Address
First Line	:	14300 GALLANT FOX LANE
Second Line	:	SUITE 226
City	:	BOWIE
State	:	MD
Zip	:	20715-3006
Country	:	US
Telephone Number	:	301-262-8900
Fax Number	:	301-262-0195

Provider Business Practice Location Address
First Line	:	6409 CRAIN HWY
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-4139
Country	:	US
Telephone Number	:	301-952-8614
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	04/22/2020

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