Provider Demographics
NPI:1902863525
Name:EGLSEDER, W. ANDREW JR (MD)
Entity Type:Individual
Prefix:
First Name:W.
Middle Name:ANDREW
Last Name:EGLSEDER
Suffix:JR
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:PO BOX 64881
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4881
Mailing Address - Country:US
Mailing Address - Phone:410-448-6332
Mailing Address - Fax:410-448-6296
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-6280
Practice Address - Fax:410-328-2893
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM31666174400000X
MDD0033077207XX0801X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No174400000XOther Service ProvidersSpecialist
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1902863525OtherNPI
MD081571300Medicaid
MD1902863525OtherNPI
MD081571300Medicaid
MDP00095094Medicare PIN