Provider Demographics
NPI:1700572518
Name:MARYLAND PHYSICIANS EDGE LLC
Entity Type:Organization
Organization Name:MARYLAND PHYSICIANS EDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-681-6772
Mailing Address - Street 1:10750 COLUMBIA PIKE STE 700
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4461
Mailing Address - Country:US
Mailing Address - Phone:301-681-6772
Mailing Address - Fax:301-681-2773
Practice Address - Street 1:12240 INDIAN CREEK CT # 130A
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-1242
Practice Address - Country:US
Practice Address - Phone:301-681-6772
Practice Address - Fax:301-681-2773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-14
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory