Provider Demographics
NPI:1548269285
Name:EDWARDS, JEREMY VAUGHAN (DO)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:VAUGHAN
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21320 RIDGECROFT DR
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-1818
Mailing Address - Country:US
Mailing Address - Phone:808-233-9121
Mailing Address - Fax:
Practice Address - Street 1:4494 NORTH PALMER ROAD DEPARTMENT OF PEDIATRICS
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5001
Practice Address - Country:US
Practice Address - Phone:301-400-3327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2020-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS951208000000X, 2080P0207X, 2080H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology