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NPI Code Detail

MEDICARE: KAREN LESLIE EDER ATC

MEDICARE: KAREN LESLIE EDER ATC
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
12255A2300XAthletic TrainerA0000107MD

General Provider Information

NPI Number : 1376001735
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN LESLIE EDER ATC
Provider Business Mailing Address
First Line : 510 UPPER CHESAPEAKE DR STE 417
Second Line :
City : BEL AIR
State : MD
Zip : 21014-4336
Country : US
Telephone Number : 443-643-3130
Fax Number : 443-643-3133
Provider Business Practice Location Address
First Line : 510 UPPER CHESAPEAKE DR STE 417
Second Line :
City : BEL AIR
State : MD
Zip : 21014-4336
Country : US
Telephone Number : 443-643-3130
Fax Number : 443-643-3133
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2019
Last Update Date : 03/05/2019

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Directions to “ KAREN LESLIE EDER ATC” Practice Location

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