Healthcare Provider Details

I. General information

NPI: 1417249434
Provider Name (Legal Business Name): KRISTA MARIE EDELMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 WILKES RIDGE PKWY STE 202
RICHMOND VA
23233
US

IV. Provider business mailing address

PO BOX 980509 IM: INTERNAL MEDICINE
RICHMOND VA
23298-0509
US

V. Phone/Fax

Practice location:
  • Phone: 804-330-7840
  • Fax: 804-740-4208
Mailing address:
  • Phone: 804-828-9726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101255094
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: