Provider Demographics
NPI:1740690973
Name:WHITFIELD, EDWARD COLUMBUS SR (MSW)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:COLUMBUS
Last Name:WHITFIELD
Suffix:SR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 MADISON PARK DR
Mailing Address - Street 2:GLEN BURNIE
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5613
Mailing Address - Country:US
Mailing Address - Phone:410-768-2719
Mailing Address - Fax:410-424-2983
Practice Address - Street 1:1419 MADISON PARK DR
Practice Address - Street 2:GLEN BURNIE
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5613
Practice Address - Country:US
Practice Address - Phone:410-768-2719
Practice Address - Fax:410-424-2983
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1104983568Medicaid