Provider Demographics
NPI:1710919899
Name:EDELMAN, JONATHAN SAMUEL
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:SAMUEL
Last Name:EDELMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-3755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-13116207L00000X
CAC153720207L00000X
LAMD.206972207L00000X
FLME102194207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04475529Medicaid
LA2371177Medicaid
FL53565OtherBCBS
559289-01OtherACS
673914OtherUHA
A001OtherCHAMPUS TRICARE
0000250837OtherHMSA
FLAM191VMedicare PIN
FLAM191UMedicare PIN
0000250837OtherHMSA
LA2371177Medicaid
FLAM191ZMedicare PIN
MS04475529Medicaid
H100127Medicare PIN
FLAM191YMedicare PIN
FLAM191WMedicare PIN