Provider Demographics
NPI:1932107018
Name:ADELSON, ANDREW JAY (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAY
Last Name:ADELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1155 21ST ST NW
Mailing Address - Street 2:LBBY M400
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-3336
Mailing Address - Country:US
Mailing Address - Phone:202-496-9181
Mailing Address - Fax:202-496-9180
Practice Address - Street 1:1155 21ST ST NW
Practice Address - Street 2:LBBY M400
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3336
Practice Address - Country:US
Practice Address - Phone:202-496-9181
Practice Address - Fax:202-496-9180
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DC14897207W00000X
DCMD14897207W00000X
MDD0036917207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
402665Medicare PIN
E63721Medicare UPIN