Healthcare Provider Details

I. General information

NPI: 1033322151
Provider Name (Legal Business Name): CHRISTOPHER M EDELMANN,M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 SHERWOOD PL
GREENWICH CT
06830-5638
US

IV. Provider business mailing address

42 SHERWOOD PL
GREENWICH CT
06830-5638
US

V. Phone/Fax

Practice location:
  • Phone: 203-869-0502
  • Fax: 203-869-1852
Mailing address:
  • Phone: 203-869-0502
  • Fax: 203-869-1852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036755
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number035851
License Number StateCT

VIII. Authorized Official

Name: DR. CHRISTOPHER M EDELMANN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 203-869-0502