Provider Demographics
NPI:1003815374
Name:ABBOUD, ELIAS MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:MICHAEL
Last Name:ABBOUD
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 1:261 OLD YORK RD
Mailing Address - Street 2:THE PAVILION STE 325
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3706
Mailing Address - Country:US
Mailing Address - Phone:215-572-7900
Mailing Address - Fax:215-884-3901
Practice Address - Street 1:261 OLD YORK RD
Practice Address - Street 2:STE 325
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3706
Practice Address - Country:US
Practice Address - Phone:215-572-7900
Practice Address - Fax:215-884-3901
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040110L207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BA1930797OtherDFA LICENSE
PA407963OtherBCBS OF PA
PA7080246Medicaid
407963Medicare ID - Type Unspecified
PA7080246Medicaid