Provider Demographics
NPI:1417249434
Name:EDELMAN, KRISTA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:MARIE
Last Name:EDELMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 980509
Mailing Address - Street 2:IM: INTERNAL MEDICINE
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0509
Mailing Address - Country:US
Mailing Address - Phone:804-828-9726
Mailing Address - Fax:
Practice Address - Street 1:1630 WILKES RIDGE PKWY STE 202
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233
Practice Address - Country:US
Practice Address - Phone:804-330-7840
Practice Address - Fax:804-740-4208
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255094207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology