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General NPI Number Information
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NPI Number | 1891374989
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Entity Type | Individual
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Provider Name | RYAN MATTHEW EDELBROCK MD
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Gender | Male
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Dates
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Enumeration Date | 04/06/2021
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Last Update Date | 07/12/2024
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Provider Practice Location Address
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Address Line | 101 E WOOD ST
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City | SPARTANBURG
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State | SC
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Zip | 29303-3040
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Country | US
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Telephone | 864-560-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 METROHEALTH DR
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City | CLEVELAND
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State | OH
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Zip | 44109-1900
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Country | US
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Telephone | 216-778-4486
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD91450
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License Number State | SC
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