Provider Demographics
NPI:1306835145
Name:ELOVIC, ELIE PAUL (MD)
Entity Type:Individual
Prefix:
First Name:ELIE
Middle Name:PAUL
Last Name:ELOVIC
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 1:101 E OLNEY AVENUE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2421
Mailing Address - Country:US
Mailing Address - Phone:215-456-7000
Mailing Address - Fax:215-456-5926
Practice Address - Street 1:1495 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1479
Practice Address - Country:US
Practice Address - Phone:775-982-3500
Practice Address - Fax:775-982-3665
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16186208100000X
NJ25MA05971300208100000X
PAMD032799E208100000X
UT7277536-1205208100000X
OH35134992208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
10655580OtherCAQH
NV1306835145Medicaid
10655580OtherCAQH