Provider Demographics
NPI:1801858014
Name:EDELSON, MARY B (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:B
Last Name:EDELSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1333 TAYLOR ST
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2923
Mailing Address - Country:US
Mailing Address - Phone:803-254-2706
Mailing Address - Fax:803-254-1318
Practice Address - Street 1:1333 TAYLOR ST
Practice Address - Street 2:SUITE 6A
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2923
Practice Address - Country:US
Practice Address - Phone:803-254-2706
Practice Address - Fax:803-254-1318
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2008-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC201982080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG17626Medicare UPIN