Provider Demographics
NPI:1891750956
Name:VAN OEVEREN, EDWARD LANIER (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LANIER
Last Name:VAN OEVEREN
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 1:3304 PATRICK HENRY DR
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-1514
Mailing Address - Country:US
Mailing Address - Phone:703-532-5142
Mailing Address - Fax:
Practice Address - Street 1:3304 PATRICK HENRY DR
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-1514
Practice Address - Country:US
Practice Address - Phone:703-532-5142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010562952083P0901X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004975138Medicaid
VA004975596Medicaid
VA004975821Medicaid
VA004975596Medicaid