Provider Demographics
NPI:1215904826
Name:HUYCKE, EDWARD CARL (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:CARL
Last Name:HUYCKE
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 1:3017 N NOTTINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-1269
Mailing Address - Country:US
Mailing Address - Phone:202-273-5806
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF VETERANS AFFAIRS
Practice Address - Street 2:810 VERMONT AVE, NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20420-0001
Practice Address - Country:US
Practice Address - Phone:202-273-5806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-18243207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease