MEDICARE: DR. EDWARD MARTIN DRUY M.D.

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	2085R0202X	Diagnostic Radiology Physician	D0017904	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

General Provider Information

NPI Number	:	1932170388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD MARTIN DRUY M.D.

Provider Business Mailing Address
First Line	:	22 S GREENE ST, DEPT OF RADIOLOGY
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21201-1544
Country	:	US
Telephone Number	:	410-328-3477
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 GARRETT AVE, DEPT OF RADIOLOGY
Second Line	:
City	:	LA PLATA
State	:	MD
Zip	:	20646-5960
Country	:	US
Telephone Number	:	301-609-4000
Fax Number	:

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	04/25/2019

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