Provider Demographics
NPI:1043433816
Name:FOLSOM ELDER, MICHELLE ANTOINETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ANTOINETTE
Last Name:FOLSOM ELDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ANTOINETTE
Other - Last Name:FOLSOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:110 HOSPITAL RD STE 111
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4039
Mailing Address - Country:US
Mailing Address - Phone:410-535-4488
Mailing Address - Fax:443-771-8114
Practice Address - Street 1:110 HOSPITAL RD STE 111
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4039
Practice Address - Country:US
Practice Address - Phone:410-535-4488
Practice Address - Fax:443-771-8114
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0067487207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine