Healthcare Provider Details

I. General information

NPI: 1497765069
Provider Name (Legal Business Name): HOWARD ELLIS EDELSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST STREET OAKCARE MEDICAL GROUP
OAKLAND CA
94602-1080
US

IV. Provider business mailing address

1411 E 31ST STREET OAKCARE MEDICAL GROUP
OAKLAND CA
94602-1080
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-4323
  • Fax: 510-437-5042
Mailing address:
  • Phone: 510-437-4323
  • Fax: 510-437-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberG050259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: