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NPI Code Detail

MEDICARE: DR. RICHARD I EDELSON PH.D

MEDICARE: DR. RICHARD I EDELSON PH.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
1103G00000XClinical Neuropsychologist286KY

General Provider Information

NPI Number : 1518968205
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD I EDELSON PH.D
Provider Business Mailing Address
First Line : 7511 NEW LAGRANGE RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40222-4859
Country : US
Telephone Number : 502-423-1151
Fax Number : 502-423-1748
Provider Business Practice Location Address
First Line : 7511 NEW LAGRANGE RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40222-4859
Country : US
Telephone Number : 502-423-1151
Fax Number : 502-423-1748
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2005
Last Update Date : 06/01/2009

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