Provider Demographics
NPI:1225183734
Name:ELMAN RETINA GROUP PA
Entity Type:Organization
Organization Name:ELMAN RETINA GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-686-3000
Mailing Address - Street 1:9114 PHILADELPHIA RD STE 310
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4350
Mailing Address - Country:US
Mailing Address - Phone:410-686-3000
Mailing Address - Fax:410-686-3690
Practice Address - Street 1:9114 PHILADELPHIA RD STE 310
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4350
Practice Address - Country:US
Practice Address - Phone:410-686-3000
Practice Address - Fax:410-686-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0032515207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD015506300Medicaid
MD015506300Medicaid