Provider Demographics
NPI:1528004900
Name:EDMUNDS, EVELYN PAGE (PHD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:PAGE
Last Name:EDMUNDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 CHATSWORTH CT
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-1503
Mailing Address - Country:US
Mailing Address - Phone:410-877-7825
Mailing Address - Fax:410-877-1897
Practice Address - Street 1:1208 E CHURCHVILLE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3442
Practice Address - Country:US
Practice Address - Phone:410-893-1407
Practice Address - Fax:410-877-1897
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02189103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0 G568 EP 62OtherCAREFIRST PROVIDER #
MD221875OtherCOMPSYCH PROVIDER #
MD100026480001OtherAPS PROVIDER #
MH002410OtherVALUE OPTIONS PROVIDER #
MDG568Medicare ID - Type UnspecifiedPROVIDER NUMBER