Provider Demographics
NPI:1093706228
Name:SIMPSON, EDWARD CALVIN (CSA)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:CALVIN
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:POMFRET
Mailing Address - State:MD
Mailing Address - Zip Code:20675-0277
Mailing Address - Country:US
Mailing Address - Phone:301-752-1578
Mailing Address - Fax:301-392-1177
Practice Address - Street 1:4850 BRIERWOOD RD
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5602
Practice Address - Country:US
Practice Address - Phone:301-392-1177
Practice Address - Fax:301-392-1177
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-05
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
521800757OtherFED TAX I.D. #