Provider Demographics
NPI:1376519322
Name:TORTOLANI, EDMUND CONRAD (MD)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:CONRAD
Last Name:TORTOLANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5072 LAKE CIR W
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1442
Mailing Address - Country:US
Mailing Address - Phone:410-997-1448
Mailing Address - Fax:
Practice Address - Street 1:5900 CEDAR LN
Practice Address - Street 2:JOHNS HOPKINS @ CEDAR LANE
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3635
Practice Address - Country:US
Practice Address - Phone:410-964-2306
Practice Address - Fax:410-715-6504
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018108174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB66899Medicare UPIN
MD8607Medicare ID - Type Unspecified