Basic Information
| Provider Information | |||||||||
| NPI: | 1902806409 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EDEN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12622 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434815047 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Practice Location | |||||||||
| Address1: | 2002 MEDICAL PKWY | ||||||||
| Address2: | SUITE 460 | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434814080 | ||||||||
| FaxNumber: | 4434814650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 04/19/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D0030701 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 352161300 | 05 | MD | MEDICAID | 606897000 | 01 | MD | FEDERAL WORKMAN'S COMP | OTHER | 0001 | 01 | DC | BCBS | OTHER | 1070096 | 01 | MD | UNITED HEALTHCARE | OTHER | 4067774 | 01 | MD | AETNA PPO | OTHER | 0108323 | 01 | MD | AMERICHOICE | OTHER | KAISER | 01 | MD | 10572 | OTHER | AETNA HMO | 01 | MD | 521295 | OTHER | 2133455 | 01 | MD | MAMSI | OTHER | 42571202 | 01 | MD | BCBS | OTHER |