Provider Demographics
NPI:1750385696
Name:EDELSTEIN, MARK R (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:EDELSTEIN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1999 SPROUL RD
Mailing Address - Street 2:STE 21
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3508
Mailing Address - Country:US
Mailing Address - Phone:610-353-6400
Mailing Address - Fax:610-356-1204
Practice Address - Street 1:1999 SPROUL RD
Practice Address - Street 2:STE 21
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3508
Practice Address - Country:US
Practice Address - Phone:610-353-6400
Practice Address - Fax:610-356-1204
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2008-01-23
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Provider Licenses
StateLicense IDTaxonomies
PAMD058772L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016417900003Medicaid
PA231718130OtherTRICARE
PA231718130OtherCIGNA
PA231718130OtherUNITED HEALTHCARE
PA0313056000OtherKEYSTONE
PACF6196OtherRAILROAD MEDICARE
PA897869OtherBLUE SHIELD