Provider Demographics
NPI:1427011048
Name:ELSON, CRAIG ELLSWORTH (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ELLSWORTH
Last Name:ELSON
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:PO BOX 52990
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-0048
Mailing Address - Country:US
Mailing Address - Phone:843-223-3600
Mailing Address - Fax:843-223-6054
Practice Address - Street 1:7301 COLLEGE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1937
Practice Address - Country:US
Practice Address - Phone:913-341-6297
Practice Address - Fax:913-341-6299
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS429909207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202973624Medicaid
KS100124780CMedicaid
KS220019250Medicare PIN
D93519Medicare UPIN
KS100124780CMedicaid
KS102907Medicare PIN
MO220019250Medicare PIN
MOJ71A00004Medicare PIN
MO202973624Medicaid