Provider Demographics
NPI:1528256633
Name:MWRDC OF ANNAPOLIS
Entity type:Organization
Organization Name:MWRDC OF ANNAPOLIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-907-3939
Mailing Address - Street 1:4915 AUBURN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2636
Mailing Address - Country:US
Mailing Address - Phone:301-907-3939
Mailing Address - Fax:301-656-3943
Practice Address - Street 1:1908 FOREST DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4340
Practice Address - Country:US
Practice Address - Phone:410-897-9854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0029010207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CK8259OtherRAILROAD
MD496601500Medicaid
MD496601500Medicaid