Individual provider Active NPI

Lanny Edelsohn, M.D.

  • Neurology Physician
  • Newark, DE
National Provider Identifier
1174574305
Registry record updated Jun 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
C1-0D00629 Issued in DE
Practice address
774 Christiana Rd
Suite 201
Newark, DE 19713-4236
Phone
(302) 731-3017
Fax
(302) 266-9960
NPI assigned
May 12, 2006
Last updated
Jun 13, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X C1-0D00629 DE Primary

Addresses

Primary practice location

774 Christiana Rd
Suite 201
Newark, DE 19713-4236

Mailing address

774 Christiana Rd
Suite 201
Newark, DE 19713-4236
Phone (302) 731-3017

Other identifiers 1

IdentifierTypeStateIssuer
127801MedicaidDE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091022000686 DE Practitioner - Neurology 0345290011 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C1-0D00629DEMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Christiana Care Health Services, Inc Neurology CurrentSince Mar 1, 2000 Accepting new patients
Christiana Care Health Services, Inc Neurology CurrentSince Oct 8, 2013 Accepting new patients
Christiana Care Health Services Inc Neurology CurrentSince Jul 31, 2009 Accepting new patients
Christiana Care Health Services, Inc Current Accepting new patients
Christiana Care Health Services Inc Neurology CurrentSince Mar 1, 2000 Accepting new patients
Neurology Associates, PA Neurology PastSince Jan 31, 2005 Accepting new patients

Locations

4755 Ogletown Stanton Rd
Newark, DE 19718
Phone (302) 733-1700

774 Christiana Rd
Ste 201
Newark, DE 19713
Phone (302) 623-3017

1401 Foulk Rd
Ste 100B
Wilmington, DE 19803
Phone (302) 320-9440

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371081600000",
    "number": "1174574305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "774 CHRISTIANA RD",
            "address_2": "SUITE 201",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197134236",
            "telephone_number": "302-731-3017",
            "fax_number": "302-266-9960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "774 CHRISTIANA RD",
            "address_2": "SUITE 201",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197134236",
            "telephone_number": "302-731-3017",
            "fax_number": "302-266-9960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDELSOHN",
        "first_name": "LANNY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2013-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "DE",
            "license": "C1-0D00629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127801",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

Verify at the official NPI Registry.