Provider Demographics
NPI:1588780639
Name:EDELSON, RICHARD NATHEN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:NATHEN
Last Name:EDELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7426 HAMPDEN LN
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1366
Mailing Address - Country:US
Mailing Address - Phone:301-951-0195
Mailing Address - Fax:301-907-2979
Practice Address - Street 1:7426 HAMPDEN LN
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1366
Practice Address - Country:US
Practice Address - Phone:301-951-0195
Practice Address - Fax:301-907-2979
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO155802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC87755Medicare UPIN