Provider Demographics
NPI:1932170388
Name:DRUY, EDWARD MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MARTIN
Last Name:DRUY
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 1:22 S GREENE ST, DEPT OF RADIOLOGY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1544
Mailing Address - Country:US
Mailing Address - Phone:410-328-3477
Mailing Address - Fax:
Practice Address - Street 1:5 GARRETT AVE, DEPT OF RADIOLOGY
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5960
Practice Address - Country:US
Practice Address - Phone:301-609-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00179042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD469661100Medicaid
MD469661100Medicaid
MDJ062OtherB/C B/S
MDKA80OtherB/C B/S
MDKA80OtherB/C B/S
MDCN2566Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MD434L4194Medicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 01
MD469661100Medicaid
DEDD4343Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MDJ062OtherB/C B/S
MDCD4495Medicare ID - Type UnspecifiedRAILROAD MEDICARE