Mark David Edelstein, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

C41340 Issued in CA

Practice address

1933 9TH Ave
Sacramento, CA 95818-4214

Phone

(916) 442-4682

NPI assigned

Aug 14, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: mark.edelstein.p1@direct.tpcp.nextgenshare.com

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332201600000",
    "number": "1972516714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1933 9TH AVE",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958184214",
            "telephone_number": "916-442-4682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1933 9TH AVE",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958184214",
            "telephone_number": "916-442-4682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDELSTEIN",
        "first_name": "MARK",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2012-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "CA",
            "license": "C41340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL PIN",
            "identifier": "00C41340(0)",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SAN JOAQUIN COUNTY MENTAL HEALTH DEPT.",
            "identifier": "1238",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SACRAMENTO CY. PROVIDER #",
            "identifier": "1177",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Douglas Eddy, PT OCS CSCS
• William Eddy, MD
• Jurian Tyler Edelenbos, DO
• Tonja M. Edelman, BSW
• Ellen Scott Edelstein, LCSW
• Jonathan Edens, PA
• Anke Z Eder, M.D.
• Corwin Eder
• Shelley Eder, M.D.
• Jessica Edgar, MS

• Child & Adolescent Psychiatry Physician in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Child & Adolescent Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.