Basic Information
Provider Information
NPI: 1275141376
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EDELSTEIN
FirstName: RACHEL
MiddleName: VERONICA
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8110 MAPLE LAWN BLVD STE 235
Address2:  
City: FULTON
State: MD
PostalCode: 207592694
CountryCode: US
TelephoneNumber: 3013408339
FaxNumber:  
Practice Location
Address1: 844 WASHINGTON RD STE 302
Address2:  
City: WESTMINSTER
State: MD
PostalCode: 211576664
CountryCode: US
TelephoneNumber: 4108762003
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/15/2020
LastUpdateDate: 04/28/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/28/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000XAC003205MDY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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