Provider Demographics
NPI:1205398070
Name:EDBERG, DAVID THOMAS (MD, MA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:THOMAS
Last Name:EDBERG
Suffix:
Gender:M
Credentials:MD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8875 AERO DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2251
Mailing Address - Country:US
Mailing Address - Phone:619-400-5170
Mailing Address - Fax:619-500-5154
Practice Address - Street 1:8875 AERO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2251
Practice Address - Country:US
Practice Address - Phone:619-400-5170
Practice Address - Fax:619-500-5154
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1765352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry