Provider Demographics
NPI:1033322151
Name:CHRISTOPHER M EDELMANN,M.D.,P.C.
Entity Type:Organization
Organization Name:CHRISTOPHER M EDELMANN,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:EDELMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-869-0502
Mailing Address - Street 1:42 SHERWOOD PL
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5638
Mailing Address - Country:US
Mailing Address - Phone:203-869-0502
Mailing Address - Fax:203-869-1852
Practice Address - Street 1:42 SHERWOOD PL
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5638
Practice Address - Country:US
Practice Address - Phone:203-869-0502
Practice Address - Fax:203-869-1852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036755207R00000X
CT035851207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02629Medicare ID - Type UnspecifiedGROUP MEDICARE