Basic Information
| Provider Information | |||||||||
| NPI: | 1851889158 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EDGAR | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2445 ARMY NAVY DR FL 4 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222062988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038926500 | ||||||||
| FaxNumber: | 7037698437 | ||||||||
| Practice Location | |||||||||
| Address1: | 1850 TOWN CENTER PKWY STE 459 | ||||||||
| Address2: | |||||||||
| City: | RESTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201903300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038926500 | ||||||||
| FaxNumber: | 7037698437 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2018 | ||||||||
| LastUpdateDate: | 10/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | D0094921 | MD | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS0010X | MD473773 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207QS0010X | 0101275769 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.