Provider Demographics
NPI:1730202912
Name:EDDY, DAVID R (PHD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:R
Last Name:EDDY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11404 OLD GEORGETOWN ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-881-5981
Mailing Address - Fax:301-881-1366
Practice Address - Street 1:11404 OLD GEORGETOWN ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:301-881-5981
Practice Address - Fax:301-881-1366
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM081106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist