Provider Demographics
NPI:1265634190
Name:ZIPPORAH ELAN
Entity Type:Organization
Organization Name:ZIPPORAH ELAN
Other - Org Name:HOME PROSTHETICARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ELAN
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:410-486-4796
Mailing Address - Street 1:301 REISTERSTOWN RD
Mailing Address - Street 2:FL 1
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5313
Mailing Address - Country:US
Mailing Address - Phone:410-486-4796
Mailing Address - Fax:410-486-9749
Practice Address - Street 1:301 REISTERSTOWN RD
Practice Address - Street 2:FL 1
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-5313
Practice Address - Country:US
Practice Address - Phone:410-486-4796
Practice Address - Fax:410-486-9749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACP2000335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
59336OtherAMERIGROUP
Y120OtherBCBS
MD501038100Medicaid
63340001OtherBCBS
1028269OtherACM
58080901OtherBCBS
63340001OtherBCBS