Provider Demographics
NPI:1821299306
Name:EDELMAN, BARRY LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:LOUIS
Last Name:EDELMAN
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 1:1324 AGATE ST
Mailing Address - Street 2:#10
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2366
Mailing Address - Country:US
Mailing Address - Phone:310-713-3180
Mailing Address - Fax:
Practice Address - Street 1:2200 PACIFIC COAST HWY STE 304A
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2702
Practice Address - Country:US
Practice Address - Phone:310-713-3180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG798792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry