Healthcare Provider Details

I. General information

NPI: 1164774295
Provider Name (Legal Business Name): PHILIP ANDREW EDELMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2012
Last Update Date: 10/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

PO BOX 151
GREAT FALLS VA
22066-0151
US

V. Phone/Fax

Practice location:
  • Phone: 703-757-9603
  • Fax:
Mailing address:
  • Phone: 703-757-9603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberMD31020
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2083T0002X
TaxonomyMedical Toxicology (Preventive Medicine) Physician
License NumberMD31020
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: