Healthcare Provider Details

I. General information

NPI: 1669483483
Provider Name (Legal Business Name): MARK H. EDELMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9055 KATY FWY SUITE 304
HOUSTON TX
77024-1624
US

IV. Provider business mailing address

9055 KATY FWY SUITE 304
HOUSTON TX
77024-1624
US

V. Phone/Fax

Practice location:
  • Phone: 713-365-9990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberH6186
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: