Basic Information
| Provider Information | |||||||||
| NPI: | 1194821470 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EDWARDS | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | REGINA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14300 GALLANT FOX LANE | ||||||||
| Address2: | SUITE 226 | ||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207153006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012628900 | ||||||||
| FaxNumber: | 3012620195 | ||||||||
| Practice Location | |||||||||
| Address1: | 6409 CRAIN HWY | ||||||||
| Address2: | |||||||||
| City: | UPPER MARLBORO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207724139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019528614 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 04/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0032051 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | D0032051 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 161021000 | 05 | MD | MEDICAID | 010078200 | 05 | DC | MEDICAID | 3252AR11 | 01 | MD | BCBS | OTHER | 2183 | 01 | DC | BCBS | OTHER |