Organization
EDGE MEDICAL CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE C EGO-OSUALA MD., FACP. (PRESIDENT)
(301) 434-9147
Entity
Organization
Contact information
Practice address
5305 KENILWORTH AVE, STE 100, RIVERDALE, MD 20737-3110
(301) 277-7110
Mailing address
PO BOX 7909, LANGLEY PARK, MD 20787-7909
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
D 47156
MD
261QP2300X
Primary Care Clinic/Center
MD 21355
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
852000300
—
MD
01
—
G02849
MEDICARE GROUP PTAN
MD
Enumeration date
06/15/2005
Last updated
07/10/2008
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