Provider Demographics
NPI:1326133034
Name:ILIADIS, ELIAS A (MD)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:A
Last Name:ILIADIS
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 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-968-7433
Mailing Address - Fax:856-968-8499
Practice Address - Street 1:900 CENTENNIAL BLVD
Practice Address - Street 2:BUILDING 2 SUITE 202
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4637
Practice Address - Country:US
Practice Address - Phone:856-325-6700
Practice Address - Fax:856-325-6702
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA074027207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1172653OtherHORISON NJ HEALTH
NJ8856508Medicaid
2117895000OtherAMERIHEALTH, KEYSTONE, IBC
NJ8856508Medicaid
G99195Medicare UPIN