Provider Demographics
NPI:1740508506
Name:EDELL, AIMEE ROSANN-PECK (MD)
Entity type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:ROSANN-PECK
Last Name:EDELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AIMEE
Other - Middle Name:ROSANN
Other - Last Name:PECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5801 NORRIS CANYON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-5440
Mailing Address - Country:US
Mailing Address - Phone:925-830-8823
Mailing Address - Fax:
Practice Address - Street 1:5801 NORRIS CANYON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5440
Practice Address - Country:US
Practice Address - Phone:925-830-8823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136631207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE400159695Medicare PIN