Provider Demographics
NPI:1326118084
Name:ELWYN, KATHERINE E (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:E
Last Name:ELWYN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 E MAIN ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3027
Mailing Address - Country:US
Mailing Address - Phone:914-244-9058
Mailing Address - Fax:914-244-9045
Practice Address - Street 1:344 E MAIN ST
Practice Address - Street 2:SUITE 403
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3027
Practice Address - Country:US
Practice Address - Phone:914-244-9058
Practice Address - Fax:914-244-9045
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133233-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY98A721Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
NYB20722Medicare UPIN