Provider Demographics
NPI:1003921784
Name:VAN DEN ELZEN, MARKETA (MD)
Entity Type:Individual
Prefix:
First Name:MARKETA
Middle Name:
Last Name:VAN DEN ELZEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102-1199 MAINASIDE CRES.
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:BC
Mailing Address - Zip Code:V6Z2Y2
Mailing Address - Country:CA
Mailing Address - Phone:604-682-6413
Mailing Address - Fax:
Practice Address - Street 1:2102-1199 MAINASIDE CRES.
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:BC
Practice Address - Zip Code:V6Z2Y2
Practice Address - Country:CA
Practice Address - Phone:604-682-6413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2235482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology