Provider Demographics
NPI:1619203668
Name:EDMUNDS, MAGDALEN (MD)
Entity Type:Individual
Prefix:
First Name:MAGDALEN
Middle Name:
Last Name:EDMUNDS
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 1:995 POTRERO AVE BLDG 80
Mailing Address - Street 2:ATTENTION: CREDENTIALING DEPT.
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2859
Mailing Address - Country:US
Mailing Address - Phone:415-206-5252
Mailing Address - Fax:415-206-8387
Practice Address - Street 1:995 POTRERO AVE BLDG 80
Practice Address - Street 2:ATTENTION: CREDENTIALING DEPT.
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2859
Practice Address - Country:US
Practice Address - Phone:415-206-5252
Practice Address - Fax:415-206-8387
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine