Provider Demographics
NPI:1538109707
Name:ELENA ANNOPOLSKY M.D.P.C.
Entity Type:Organization
Organization Name:ELENA ANNOPOLSKY M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNOPOLSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-698-1995
Mailing Address - Street 1:9150 MARSHALL ST
Mailing Address - Street 2:STE 17
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9150 MARSHALL ST
Practice Address - Street 2:STE 17
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2217
Practice Address - Country:US
Practice Address - Phone:215-698-1995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067857L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017564570005Medicaid
PA0017564570005Medicaid
PA027053Medicare ID - Type Unspecified