Provider Demographics
NPI:1447436712
Name:EDELMAN, EVA JENNIFER (MD)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:JENNIFER
Last Name:EDELMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:E.
Other - Middle Name:JENNIFER
Other - Last Name:EDELMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:333 CEDAR ST
Mailing Address - Street 2:YSM, GENERAL INTERNAL MEDICINE, PO BOX 208093
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3206
Mailing Address - Country:US
Mailing Address - Phone:203-688-6532
Mailing Address - Fax:
Practice Address - Street 1:15 YORK ST
Practice Address - Street 2:NATHAN SMITH CLINIC
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3221
Practice Address - Country:US
Practice Address - Phone:203-688-5303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046624207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine