Provider Demographics
NPI:1518904291
Name:MCDEVITT, EDWARD ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ROBERT
Last Name:MCDEVITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1630 MAIN STREET
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21619
Mailing Address - Country:US
Mailing Address - Phone:410-643-3410
Mailing Address - Fax:410-643-5938
Practice Address - Street 1:1600 S CRAIN HIGHWAY
Practice Address - Street 2:SUITE 401
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-768-5050
Practice Address - Fax:410-768-7830
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2013-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0035604207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E35824Medicare UPIN