Provider Demographics
NPI:1326008780
Name:ELANGBAM, DILIP KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:DILIP
Middle Name:KUMAR
Last Name:ELANGBAM
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 1:10 SHADY LN STE 201
Mailing Address - Street 2:
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756-8807
Mailing Address - Country:US
Mailing Address - Phone:570-546-2505
Mailing Address - Fax:570-546-2506
Practice Address - Street 1:10 SHADY LN
Practice Address - Street 2:SUITE 201
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-8807
Practice Address - Country:US
Practice Address - Phone:570-546-2505
Practice Address - Fax:570-546-2506
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062088L207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016491700005Medicaid
PA959174F6KMedicare PIN
PA451657OtherHEALTHAMERICA
PA959174Medicare PIN
PA2517576OtherUNITEDHEALTHCARE
PA0016491700005Medicaid
PA002983OtherFIRST PRIORITY HEALTH
PA12640OtherGEISINGER HEALTH PLAN
G57281Medicare UPIN
PAP00009323Medicare PIN
PA959174OtherHIGHMARK BLUE SHIELD