Provider Demographics
NPI:1831131739
Name:EDELMAN, GERALD (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
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 1:801 W INTERSTATE 20 STE 132
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5851
Mailing Address - Country:US
Mailing Address - Phone:682-274-8181
Mailing Address - Fax:817-764-0175
Practice Address - Street 1:801 W INTERSTATE 20 STE 132
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5851
Practice Address - Country:US
Practice Address - Phone:682-274-8181
Practice Address - Fax:817-764-0175
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.134390207RH0003X
TXJ3787207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134590201Medicaid
TX134590206Medicaid
TX134590208Medicaid
TX134590203Medicaid
OH0313541Medicaid
TX134590204Medicaid
TX8R1431OtherBLUE CROSS OF TEXAS
TX134590205Medicaid
TX134590208Medicaid
TX8L7900Medicare PIN
TX134590205Medicaid
TX134590201Medicaid
TX8D8153Medicare PIN