MEDICARE: EDGE MEDICAL CARE PC

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	261QP2300X	Primary Care Clinic/Center	MD 21355	DC
2	261QP2300X	Primary Care Clinic/Center	D 47156	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G02849	OTHER	MD	MEDICARE GROUP PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447255609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDGE MEDICAL CARE PC

Provider Business Mailing Address
First Line	:	PO BOX 7909
Second Line	:
City	:	LANGLEY PARK
State	:	MD
Zip	:	20787-7909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5305 KENILWORTH AVE
Second Line	:	STE 100
City	:	RIVERDALE
State	:	MD
Zip	:	20737-3110
Country	:	US
Telephone Number	:	301-277-7110
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GEORGE C EGO-OSUALA
Credential	:	MD., FACP.
Telephone Number	:	301-434-9147

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/10/2008

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Directions to “EDGE MEDICAL CARE PC ” Practice Location

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