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General NPI Number Information
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NPI Number | 1003056755
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Entity Type | Individual
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Provider Name | TRAVIS HOWELL EDELSTEIN D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/20/2009
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 2300 OPITZ BLVD
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3311
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Country | US
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Telephone | 703-523-0611
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Fax | 703-670-2089
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Provider Business Mailing Address
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Address Line | 1673 MASON AVE STE 305
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5516
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Country | US
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Telephone | 352-671-4300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 97821
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 0102209297
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 97821
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | OS12469
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License Number State | FL
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