Provider Demographics
NPI:1316041585
Name:BARTLETT, EDWARD L JR (MD MBA)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:L
Last Name:BARTLETT
Suffix:JR
Gender:M
Credentials:MD MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 WYMAN PARK DRIVE
Mailing Address - Street 2:SUITE 359A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211
Mailing Address - Country:US
Mailing Address - Phone:410-338-3016
Mailing Address - Fax:410-338-3420
Practice Address - Street 1:3100 WYMAN PARK DRIVE
Practice Address - Street 2:SUITE 359A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211
Practice Address - Country:US
Practice Address - Phone:410-338-3016
Practice Address - Fax:410-338-3420
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD25696208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD304111500Medicaid
D78013Medicare UPIN
BV65Medicare ID - Type Unspecified