Provider Demographics
NPI:1598755126
Name:EDELMAN, RONALD DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DAVID
Last Name:EDELMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1563 GILPIN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1630
Mailing Address - Country:US
Mailing Address - Phone:303-388-0976
Mailing Address - Fax:303-388-0978
Practice Address - Street 1:1563 GILPIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1630
Practice Address - Country:US
Practice Address - Phone:303-388-0976
Practice Address - Fax:303-388-0978
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO332213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01003326Medicaid
CO4745720001Medicare NSC
COC51453Medicare ID - Type Unspecified
CO01003326Medicaid