Lamont Randall Purpose Edwards

Individual provider Active NPI Contractor · Washington, DC

NPI 1558083907 · NPPES record last updated Sep 13, 2022

Key facts

NPI
1558083907
Entity type
Individual (NPI type 1)
Primary specialty
Contractor 171W00000X
Practice address
1418 Good Hope Rd SE
Washington, DC 20020-5615
Phone
(202) 796-5000
NPI assigned
Sep 13, 2022
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Contractor 171W00000X VA Yes

Addresses

Primary practice location

1418 Good Hope Rd SE
Washington, DC 20020-5615

Mailing address

1418 Good Hope Rd SE
Washington, DC 20020-5615
Phone (202) 796-5000

Other providers in Washington, DC

All providers in Washington, DC · Contractor in District of Columbia

Sources for this page

Verify at the official NPI Registry.