Provider Demographics
NPI:1194821470
Name:EDWARDS, ALLISON REGINA
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:REGINA
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 GALLANT FOX LANE
Mailing Address - Street 2:SUITE 226
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3006
Mailing Address - Country:US
Mailing Address - Phone:301-262-8900
Mailing Address - Fax:301-262-0195
Practice Address - Street 1:6409 CRAIN HWY
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-4139
Practice Address - Country:US
Practice Address - Phone:301-952-8614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0032051207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD161021000Medicaid
DC010078200Medicaid
MD3252AR11OtherBCBS
DC2183OtherBCBS