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General NPI Number Information
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NPI Number | 1063405819
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Entity Type | Individual
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Provider Name | MARK A EDELMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 06/04/2019
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Provider Practice Location Address
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Address Line | 1290 SUMMER ST STE 2100
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City | STAMFORD
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State | CT
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Zip | 06905-5340
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Country | US
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Telephone | 855-830-8346
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Fax |
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Provider Business Mailing Address
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Address Line | 210 WESTCHESTER AVE
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City | WHITE PLAINS
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State | NY
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Zip | 10604-2901
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Country | US
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Telephone | 914-682-6430
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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 | 036094621
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License Number State | IL
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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 | 036094621
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License Number State | IL
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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 | 172012-1
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License Number State | NY
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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 | 51858
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License Number State | CT
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