Provider Demographics
NPI:1598955791
Name:ELITE MD, INC
Entity Type:Organization
Organization Name:ELITE MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BADRESHIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-805-0663
Mailing Address - Street 1:360 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-3320
Mailing Address - Country:US
Mailing Address - Phone:717-805-0663
Mailing Address - Fax:
Practice Address - Street 1:360 ROSE AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3320
Practice Address - Country:US
Practice Address - Phone:717-805-0663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99366207NS0135X
CAA99986208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty