MEDICARE: DR. EDWARD DONALD LAYNE MD

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	207T00000X	Neurological Surgery Physician	D0008412	MD

General Provider Information

NPI Number	:	1417925264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD DONALD LAYNE MD

Provider Business Mailing Address
First Line	:	3449 WILKENS AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229-5216
Country	:	US
Telephone Number	:	410-646-9440
Fax Number	:	410-646-9443

Provider Business Practice Location Address
First Line	:	3449 WILKENS AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229-5281
Country	:	US
Telephone Number	:	410-646-9440
Fax Number	:	410-646-9443

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	07/08/2007

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