Provider Demographics
NPI:1194763268
Name:EDEN, CLARA S (MD)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:S
Last Name:EDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:CLARA
Other - Middle Name:GRACE
Other - Last Name:STEELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 79777
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0777
Mailing Address - Country:US
Mailing Address - Phone:434-654-7794
Mailing Address - Fax:434-654-7582
Practice Address - Street 1:500 MARTHA JEFFERSON DR # G236
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911
Practice Address - Country:US
Practice Address - Phone:434-654-7580
Practice Address - Fax:434-654-7582
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046609207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV6455BMedicare PIN
E14279Medicare UPIN
VAP01530542Medicare PIN