Provider Demographics
NPI:1609025733
Name:EDGCOMB, DAVID BERNAL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BERNAL
Last Name:EDGCOMB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E 9TH ST # 4K
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-5944
Mailing Address - Country:US
Mailing Address - Phone:917-478-5129
Mailing Address - Fax:
Practice Address - Street 1:20 E 9TH ST # 4K
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-5944
Practice Address - Country:US
Practice Address - Phone:917-478-5129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2607642084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine