Provider Demographics
NPI:1295719136
Name:EDGE, DEBORAH S (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:S
Last Name:EDGE
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 1:909 MASSACHUSETTS AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-6227
Mailing Address - Country:US
Mailing Address - Phone:202-546-7159
Mailing Address - Fax:
Practice Address - Street 1:60 O ST NW
Practice Address - Street 2:SOME MEDICAL CLINIC
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1259
Practice Address - Country:US
Practice Address - Phone:202-797-8806
Practice Address - Fax:202-265-0927
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD10275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCC62705Medicare UPIN
003960M07Medicare ID - Type Unspecified