Provider Demographics
NPI:1922042241
Name:BODURIAN, EDWARD NUBAR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:NUBAR
Last Name:BODURIAN
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 1:5530 WISCONSIN AVE
Mailing Address - Street 2:SUITE 515
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:301-656-4064
Mailing Address - Fax:301-651-9561
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 515
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-656-4064
Practice Address - Fax:301-651-9561
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0028064174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD32331400Medicaid
MDA575OtherCAREFIRST BLUE CROSS BLUE SHIELD
MD103252Medicare ID - Type UnspecifiedGROUP NUMBER
MD32331400Medicaid