Provider Demographics
NPI:1417925264
Name:LAYNE, EDWARD DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DONALD
Last Name:LAYNE
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 1:3449 WILKENS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5216
Mailing Address - Country:US
Mailing Address - Phone:410-646-9440
Mailing Address - Fax:410-646-9443
Practice Address - Street 1:3449 WILKENS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5281
Practice Address - Country:US
Practice Address - Phone:410-646-9440
Practice Address - Fax:410-646-9443
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0008412207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
5196Medicare ID - Type Unspecified
MDC49368Medicare UPIN