Provider Demographics
NPI:1104822899
Name:EDLOW, RICHARD CRAIG (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CRAIG
Last Name:EDLOW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8913 GRIFFIN WAY
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1424
Mailing Address - Country:US
Mailing Address - Phone:410-602-3126
Mailing Address - Fax:
Practice Address - Street 1:611 FREDERICK RD
Practice Address - Street 2:STE 101
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4779
Practice Address - Country:US
Practice Address - Phone:410-747-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0787152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD69770802OtherCAREFIRST BCBS
MD410029001OtherRAILROAD MEDICARE
MDT78701Medicare UPIN