Individual
MARK A EDELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1290 SUMMER ST STE 2100, STAMFORD, CT 06905-5340
(855) 830-8346
Mailing address
210 WESTCHESTER AVE, WHITE PLAINS, NY 10604-2901
(914) 682-6430
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
036094621
IL
2085R0204X
Vascular & Interventional Radiology Physician
036094621
IL
2085R0204X
Vascular & Interventional Radiology Physician
172012-1
NY
2085R0204X
Vascular & Interventional Radiology Physician
Primary
51858
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008047540
—
CT
05
—
01301766
—
NY
05
—
036094621
—
IL
01
—
202926
GROUP PTAN
IL
01
—
212545
GROUP PTAN
IL
Enumeration date
08/26/2005
Last updated
06/04/2019
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