Provider Demographics
NPI:1376536623
Name:MONTROSS-LOPEZ, ELISA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISA
Middle Name:M
Last Name:MONTROSS-LOPEZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:640 S STATE ST
Mailing Address - Street 2:742 BUILDING
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3530
Mailing Address - Country:US
Mailing Address - Phone:302-674-3970
Mailing Address - Fax:302-672-2350
Practice Address - Street 1:630 MULBERRY STREET
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968
Practice Address - Country:US
Practice Address - Phone:302-684-8053
Practice Address - Fax:302-684-8059
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2012-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DEC1-0004991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0002OtherCAREFIRST BCBS DC
DE0000821101Medicaid
DE5728537OtherAETNA
DE080107124OtherRAILROAD MEDICARE
DE0420453000OtherAMERIHEALTH
DE60953701OtherCAREFIRST BCBS
DE15RG73OtherBLUE CROSS BLUE SHIELD DE
DE47279OtherPRINCIPAL HEALTHCARE
DE248021OtherMAMSI/UNITED HEALTH CARE
DE60953701OtherCAREFIRST BCBS
DE0420453000OtherAMERIHEALTH
DE15RG73OtherBLUE CROSS BLUE SHIELD DE