Provider Demographics
NPI:1063052603
Name:EDELL, CEDAR HART (DO)
Entity type:Individual
Prefix:DR
First Name:CEDAR
Middle Name:HART
Last Name:EDELL
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 SW GAINES ST APT A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3005
Mailing Address - Country:US
Mailing Address - Phone:541-729-3048
Mailing Address - Fax:
Practice Address - Street 1:MSC10 6660 1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-3005
Practice Address - Country:US
Practice Address - Phone:505-272-2610
Practice Address - Fax:505-272-1300
Is Sole Proprietor?:No
Enumeration Date:2020-01-12
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program