Provider Demographics
NPI:1265471676
Name:EDMOND-DAVIS, VICTORIA (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:EDMOND-DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:J
Other - Last Name:EDMOND DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2722 MERRILEE DR
Mailing Address - Street 2:STE 230
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4400
Mailing Address - Country:US
Mailing Address - Phone:703-698-4483
Mailing Address - Fax:703-573-0880
Practice Address - Street 1:119 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5779
Practice Address - Country:US
Practice Address - Phone:904-236-5884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00879922085R0202X
VA01012400732085R0202X
FLME1627022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010304105Medicaid
VA1371666OtherAETNA HMO
IN200381160Medicaid
VA0090OtherCAREFIRST BCBS
VA7278394OtherAETNA
VA260000OtherKAISER
VA010304083Medicaid
VA1371666OtherAETNA HMO
VA010304083Medicaid
DC019944F43Medicare PIN
VA260000OtherKAISER
IN219950DDMedicare PIN