# EDGE FAMILY MEDICINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801517453
- **Authorized official:** KELECHI EGO-OSUALA MD (OWNER)
- **Authorized official phone:** (301) 613-5376

## Contact information

- **Practice address:** 5305 KENILWORTH AVE \# 100, RIVERDALE, MD 20737-3101
- **Practice address phone:** (301) 277-7110
- **Mailing address:** 5305 KENILWORTH AVE \# 100, RIVERDALE, MD 20737-3101
- **Mailing address phone:** (301) 277-7110

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/12/2022
- **Last updated:** 09/12/2022