Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | MD064402L | PA |
NPI | 1255305546 |
---|---|
Provider Name | Mitchell I Edelson |
First Address | Willow Grove, PA 19090-1104 |
Second Address | Willow Grove, PA 19090-1104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 26/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G63883 | (02) | PA |