Provider Demographics
NPI:1558412247
Name:EDWARD P DWORKIN PH D & ANITA L DWORKIN PH D P A
Entity Type:Organization
Organization Name:EDWARD P DWORKIN PH D & ANITA L DWORKIN PH D P A
Other - Org Name:MARYLAND PSYCHOLOGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DWORKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-997-3961
Mailing Address - Street 1:10326 SIXPENCE CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3807
Mailing Address - Country:US
Mailing Address - Phone:410-997-3961
Mailing Address - Fax:410-997-3999
Practice Address - Street 1:10326 SIXPENCE CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3807
Practice Address - Country:US
Practice Address - Phone:410-997-3961
Practice Address - Fax:410-997-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD181LMedicare PIN