Provider Demographics
NPI:1437326329
Name:BRETT ELLIOTT MD PA
Entity Type:Organization
Organization Name:BRETT ELLIOTT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-422-3034
Mailing Address - Street 1:521 S DUPONT HWY
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1757
Mailing Address - Country:US
Mailing Address - Phone:302-422-3034
Mailing Address - Fax:302-269-3830
Practice Address - Street 1:521 S DUPONT HWY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1757
Practice Address - Country:US
Practice Address - Phone:302-422-3034
Practice Address - Fax:302-269-3830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-11
Last Update Date:2011-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10000780207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE123420Medicare UPIN