Provider Demographics
NPI:1508074527
Name:LANDAKER, EDWIN J (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:J
Last Name:LANDAKER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:620 JOHN PAUL JONES CIR
Mailing Address - Street 2:NAVAL MEDICAL CENTER PORTSMOUTH
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708-2111
Mailing Address - Country:US
Mailing Address - Phone:757-953-2114
Mailing Address - Fax:757-953-0839
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:NAVAL MEDICAL CENTER PORTSMOUTH
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-2114
Practice Address - Fax:757-953-0839
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2009-12-31
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Provider Licenses
StateLicense IDTaxonomies
VA01012395672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology