Provider Demographics
NPI:1407859085
Name:TAUBMAN, EDWARD PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:PHILIP
Last Name:TAUBMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18213 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1422
Mailing Address - Country:US
Mailing Address - Phone:301-774-5400
Mailing Address - Fax:301-570-4099
Practice Address - Street 1:18109 PRINCE PHILIP DR
Practice Address - Street 2:STE 275
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1576
Practice Address - Country:US
Practice Address - Phone:301-774-5400
Practice Address - Fax:301-570-4099
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023459207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD129501200Medicaid
536174Medicare PIN
MD129501200Medicaid