Provider Demographics
NPI:1902806409
Name:EDEN, ROBERT S (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:EDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:443-481-5047
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 460
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:443-481-4080
Practice Address - Fax:443-481-4650
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0030701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD352161300Medicaid
MD606897000OtherFEDERAL WORKMAN'S COMP
DC0001OtherBCBS
MD1070096OtherUNITED HEALTHCARE
MD4067774OtherAETNA PPO
MD0108323OtherAMERICHOICE
MDKAISEROther10572
MDAETNA HMOOther521295
MD2133455OtherMAMSI
MD42571202OtherBCBS
MD352161300Medicaid
MDP00259626Medicare PIN
MD129N041GMedicare PIN