Provider Demographics
NPI:1679653489
Name:EDWARDS, JOAN PATRICIA (MD)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:PATRICIA
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BROCSTER CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:MD
Mailing Address - Zip Code:21131-1922
Mailing Address - Country:US
Mailing Address - Phone:443-604-6664
Mailing Address - Fax:
Practice Address - Street 1:9 BROCSTER CT
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:MD
Practice Address - Zip Code:21131-1922
Practice Address - Country:US
Practice Address - Phone:443-604-6664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2009-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD31775207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2830503006OtherCIGNA HEALTHCARE
41309901OtherBLUE C BLUE S
MD370591900Medicaid
W1440001OtherBLUE SHEILD FEDERAL
830008489OtherMEDICARE RAILROAD
0498167OtherAETNA
D72066Medicare UPIN
2830503006OtherCIGNA HEALTHCARE
W1440001OtherBLUE SHEILD FEDERAL