Provider Demographics
NPI:1538122668
Name:ELDER, SANDRA D (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:D
Last Name:ELDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:771 ROUTE 70 EAST
Mailing Address - Street 2:SUITE D-150
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4806
Mailing Address - Country:US
Mailing Address - Phone:856-596-3393
Mailing Address - Fax:856-596-3394
Practice Address - Street 1:771 ROUTE 70 EAST
Practice Address - Street 2:SUITE D-150
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4806
Practice Address - Country:US
Practice Address - Phone:856-596-3393
Practice Address - Fax:856-596-3394
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA53938207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJFO9176Medicare UPIN