Provider Demographics
NPI:1245387083
Name:BRIAN M ELIAS DPM PC
Entity Type:Organization
Organization Name:BRIAN M ELIAS DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:814-375-8882
Mailing Address - Street 1:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-0315
Mailing Address - Country:US
Mailing Address - Phone:814-375-8882
Mailing Address - Fax:814-375-1159
Practice Address - Street 1:90 BEAVER DR BLDG E
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2440
Practice Address - Country:US
Practice Address - Phone:814-375-8882
Practice Address - Fax:814-375-1159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004352L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADF7396OtherTRAVELER'S MEDICARE
PA308924OtherUPMC
PA39998OtherGEISINGER
PA39998OtherGEISINGER
PADF7396OtherTRAVELER'S MEDICARE