Provider Demographics
NPI:1669472072
Name:AIGBEDION, ERIC O (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:O
Last Name:AIGBEDION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 ASHLEIGH GLEN CT
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9148
Mailing Address - Country:US
Mailing Address - Phone:301-356-6891
Mailing Address - Fax:
Practice Address - Street 1:7505 NEW HAMPSHIRE AVE STE 314
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6972
Practice Address - Country:US
Practice Address - Phone:301-326-2997
Practice Address - Fax:301-326-2999
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047891207P00000X, 207R00000X
VA0101058203207P00000X
DCMD046246207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005878080Medicaid
VA1669472072Medicaid
VA1802853000Medicaid
VA005860733Medicaid
VA005848415Medicaid
VAVAA102802Medicaid
VA010055636Medicaid
VA1802853000Medicaid
VA1669472072Medicaid
VA930002358Medicare PIN
VA005860733Medicaid
VA005878080Medicaid
VA010055636Medicaid
VA021347E98Medicare PIN