Active NPI
Gabriel Eidelman, PH.D.
- Clinical Psychologist
- Rockville, MD
National Provider Identifier
1013157312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 04504
- Practice address
- 15 W Montgomery Ave
Suite 201
Rockville, MD 20850-4217 - Phone
- (202) 351-6808
- NPI assigned
- Feb 26, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 04504 | MD | Primary |
Addresses
Primary practice location
15 W Montgomery Ave
Suite 201
Rockville, MD 20850-4217
Mailing address
220 Pender PL
Rockville, MD 20850-2909
Phone (301) 613-6679
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04504 | MD | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235606400000",
"number": "1013157312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "220 PENDER PL",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208502909",
"telephone_number": "301-613-6679"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 W MONTGOMERY AVE",
"address_2": "SUITE 201",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208504217",
"telephone_number": "202-351-6808"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EIDELMAN",
"first_name": "GABRIEL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-02-26",
"last_updated": "2009-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "04504",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.