Provider Demographics
NPI:1073988242
Name:DAVID ELMER MD PC
Entity Type:Organization
Organization Name:DAVID ELMER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:ELMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-771-4100
Mailing Address - Street 1:60A PARK ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-5231
Mailing Address - Country:US
Mailing Address - Phone:508-771-4100
Mailing Address - Fax:508-771-4117
Practice Address - Street 1:60A PARK ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5231
Practice Address - Country:US
Practice Address - Phone:508-771-4100
Practice Address - Fax:508-771-4117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56359174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3032205Medicaid
MAA59212Medicare UPIN