Provider Demographics
NPI:1548306046
Name:REDWOOD, ELDON ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:ELDON
Middle Name:ANTHONY
Last Name:REDWOOD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 TOURNAMENT DR
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5120
Mailing Address - Country:US
Mailing Address - Phone:914-686-2560
Mailing Address - Fax:212-939-1067
Practice Address - Street 1:506 MALCOLM X BLVD
Practice Address - Street 2:WP 450
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1802
Practice Address - Country:US
Practice Address - Phone:212-939-2678
Practice Address - Fax:212-939-1067
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY168388207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01073174Medicaid
NYG82838Medicare UPIN
NY45C941Medicare ID - Type Unspecified