Provider Demographics
NPI:1184684789
Name:EDNEY, MARK T (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:T
Last Name:EDNEY
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:1342 SOUTH DIVISION STREET
Mailing Address - Street 2:UNIT 401 PENINSULA UROLOGY ASSOCIATES PA
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21084
Mailing Address - Country:US
Mailing Address - Phone:410-546-2133
Mailing Address - Fax:210-548-3361
Practice Address - Street 1:1342 SOUTH DIVISION STREET
Practice Address - Street 2:UNIT 401 PENINSULA UROLOGY ASSOCIATES PA
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21084
Practice Address - Country:US
Practice Address - Phone:410-546-2133
Practice Address - Fax:210-548-3361
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD60185208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405034700Medicaid
MDH831Medicare ID - Type Unspecified
MD405034700Medicaid