Provider Demographics
NPI:1376702928
Name:ELLIOTT, BRIAN MARC (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MARC
Last Name:ELLIOTT
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 1:16 DOWNER AVE
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4904
Mailing Address - Country:US
Mailing Address - Phone:862-309-6096
Mailing Address - Fax:614-455-9796
Practice Address - Street 1:16 DOWNER AVE
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4904
Practice Address - Country:US
Practice Address - Phone:862-309-6096
Practice Address - Fax:614-455-9796
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-07
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251161207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology