Provider Demographics
NPI:1629035357
Name:KLONSKY, ELLIOTT JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:JOSEPH
Last Name:KLONSKY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 TRANSPORTATION BLVD STE I
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2149
Mailing Address - Country:US
Mailing Address - Phone:410-721-2500
Mailing Address - Fax:410-721-1308
Practice Address - Street 1:1702 TRANSPORTATION BLVD STE I
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2149
Practice Address - Country:US
Practice Address - Phone:410-721-2500
Practice Address - Fax:410-721-1308
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTAO687152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
X395Medicare PIN
T59950Medicare UPIN