Provider Demographics
NPI:1548285687
Name:KELMENSON, EDWARD (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:KELMENSON
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 1:36 HARBOUR ISLE DR W
Mailing Address - Street 2:#202
Mailing Address - City:HUTCHINSON ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34949-2788
Mailing Address - Country:US
Mailing Address - Phone:207-478-5944
Mailing Address - Fax:866-665-2702
Practice Address - Street 1:1700 S 23RD ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4803
Practice Address - Country:US
Practice Address - Phone:772-461-4000
Practice Address - Fax:866-665-2702
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423579207L00000X
FLME114394207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1654066OtherHIGHMARK BLUE SHIELD
PA90174OtherGEISINGER HEALTH PLAN
PA50041807OtherKEYSTONE HEALTH PLAN CENT
PA50041807OtherCAPITAL BLUE CROSS
PAP00173079Medicare ID - Type UnspecifiedRAILROAD MEDICARE
PA085583HHZMedicare ID - Type Unspecified
PA50041807OtherCAPITAL BLUE CROSS