Provider Demographics
NPI:1891863213
Name:WARD, EDWARD DUFFY (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DUFFY
Last Name:WARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:820 FOLLIN LN SE
Mailing Address - Street 2:NAVY FEDERAL WELLNESS CENTER
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4907
Mailing Address - Country:US
Mailing Address - Phone:877-222-8808
Mailing Address - Fax:703-206-1371
Practice Address - Street 1:820 FOLLIN LN SE
Practice Address - Street 2:NAVY FEDERAL WELLNESS CENTER
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4907
Practice Address - Country:US
Practice Address - Phone:877-222-8808
Practice Address - Fax:703-206-1371
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E80678Medicare UPIN
006000M92Medicare ID - Type Unspecified