MEDICARE: RICHARD HENRY EDELSON 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	174400000X	Specialist	MD18941	OR

General Provider Information

NPI Number	:	1548267263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD HENRY EDELSON M.D.

Provider Business Mailing Address
First Line	:	7300 SW CHILDS RD
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97224-7713
Country	:	US
Telephone Number	:	503-692-8700
Fax Number	:	503-692-8710

Provider Business Practice Location Address
First Line	:	7300 SW CHILDS RD
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97224-7713
Country	:	US
Telephone Number	:	503-692-8700
Fax Number	:	503-692-8710

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	12/07/2010

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