Provider Demographics
NPI:1124057013
Name:EDELMAN, BENNETT B (MD)
Entity type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:B
Last Name:EDELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64592
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4592
Mailing Address - Country:US
Mailing Address - Phone:410-328-5514
Mailing Address - Fax:410-328-0929
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:NBW73
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-5514
Practice Address - Fax:410-328-0929
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018310207ZB0001X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE15177Medicare UPIN
MD22017403Medicare PIN
MDCA9059Medicare PIN
MDC034Medicare PIN