Provider Demographics
NPI:1699746354
Name:EDINGER, BENJAMIN W (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:W
Last Name:EDINGER
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 1:7801 OLD BRANCH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1608
Mailing Address - Country:US
Mailing Address - Phone:301-856-6718
Mailing Address - Fax:301-856-6722
Practice Address - Street 1:7801 OLD BRANCH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1608
Practice Address - Country:US
Practice Address - Phone:301-856-6718
Practice Address - Fax:301-856-6722
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
MDD618492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405986700Medicaid
VA1699746354Medicaid
DCP00765654Medicare UPIN
DC153745ZCMEMedicare UPIN
MD141473ZBQ0Medicare UPIN
VA019501N94Medicare UPIN
MD405986700Medicaid