Healthcare Provider Details

I. General information

NPI: 1932124914
Provider Name (Legal Business Name): REBECCA GWEN EDELSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 BROSCHART RD
ROCKVILLE MD
20850-3303
US

IV. Provider business mailing address

4700 MORGAN DR
CHEVY CHASE MD
20815-5313
US

V. Phone/Fax

Practice location:
  • Phone: 301-251-6976
  • Fax:
Mailing address:
  • Phone: 301-915-0880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number215830-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD035505
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD0062869
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: