Provider Demographics
NPI:1558761973
Name:A. ELAINE ASHBY, M.D., INC.
Entity Type:Organization
Organization Name:A. ELAINE ASHBY, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:A. ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-283-1210
Mailing Address - Street 1:3732 MT DIABLO BLVD STE 385
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3625
Mailing Address - Country:US
Mailing Address - Phone:925-283-1210
Mailing Address - Fax:925-283-1310
Practice Address - Street 1:3732 MT DIABLO BLVD STE 385
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3625
Practice Address - Country:US
Practice Address - Phone:925-283-1210
Practice Address - Fax:925-283-1310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G519401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAPPLIED FORMedicare UPIN