Provider Demographics
NPI:1639206923
Name:POINDEXTER, EDWARD L SR (FNP)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:L
Last Name:POINDEXTER
Suffix:SR
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10320 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3313
Mailing Address - Country:US
Mailing Address - Phone:443-367-8600
Mailing Address - Fax:
Practice Address - Street 1:10320 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3313
Practice Address - Country:US
Practice Address - Phone:443-367-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR156764363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherDO NOT CURRENTLY ACCEPT INSURANCE