MEDICARE: DR. EDDY Y JOELSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	A88273	CA
2	207R00000X	Internal Medicine Physician	A88273	CA

General Provider Information

NPI Number	:	1043294580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDDY Y JOELSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 588500
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-8500
Country	:	US
Telephone Number	:	916-691-9827
Fax Number	:

Provider Business Practice Location Address
First Line	:	8260 LONGLEAF DR BLDG C
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-1322
Country	:	US
Telephone Number	:	916-691-9827
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	09/11/2023

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