Provider Demographics
NPI:1184685620
Name:WILSON-COLBERT, ELAINE V (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:V
Last Name:WILSON-COLBERT
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 1:711 W 40TH ST
Mailing Address - Street 2:SUITE 429
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2120
Mailing Address - Country:US
Mailing Address - Phone:410-554-5437
Mailing Address - Fax:410-554-5436
Practice Address - Street 1:711 W 40TH ST
Practice Address - Street 2:SUITE 429
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2120
Practice Address - Country:US
Practice Address - Phone:410-554-5437
Practice Address - Fax:410-554-5436
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025973208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD78205Medicare UPIN
MD089L114RMedicare ID - Type Unspecified