Provider Demographics
NPI:1750426292
Name:KOSENSKI, EDWARD JAMES (DC)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JAMES
Last Name:KOSENSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 LAUREL BOWIE RD 202
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4000
Mailing Address - Country:US
Mailing Address - Phone:301-352-3454
Mailing Address - Fax:301-352-0893
Practice Address - Street 1:297 MUDDY BRANCH RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-3000
Practice Address - Country:US
Practice Address - Phone:301-330-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD491924Medicare ID - Type Unspecified
MDU24086Medicare UPIN