Provider Demographics
NPI:1083775126
Name:CULLEN, EDWARD THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:THOMAS
Last Name:CULLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6188 OXON HILL ROAD
Mailing Address - Street 2:SUITE 704
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3151
Mailing Address - Country:US
Mailing Address - Phone:301-839-2790
Mailing Address - Fax:301-839-3042
Practice Address - Street 1:6188 OXON HILL ROAD
Practice Address - Street 2:SUITE 704
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3151
Practice Address - Country:US
Practice Address - Phone:301-839-2790
Practice Address - Fax:301-839-3042
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0026607207R00000X
DCMD13637207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
144561OtherUNITED HEALTH CARE
4086948OtherAETNA
41238504OtherBCBS OF MARYLAND
0202OtherBCBS NATL CAPITOL AREA
41238504OtherBCBS OF MARYLAND
D05903Medicare UPIN