Provider Demographics
NPI:1205858396
Name:ELANDER, TROY (MD)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:
Last Name:ELANDER
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 1:242 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-2559
Mailing Address - Country:US
Mailing Address - Phone:310-393-0634
Mailing Address - Fax:310-451-4001
Practice Address - Street 1:242 26TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90402-2559
Practice Address - Country:US
Practice Address - Phone:310-393-0634
Practice Address - Fax:310-451-4009
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65935207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACK5309OtherMEDICARE RAIL ROAD
EC732ZOtherPTAN FOR UCLA
CA00G659350Medicaid
CAWG65935DMedicare PIN
CACK5309OtherMEDICARE RAIL ROAD
CAE47852Medicare UPIN