Provider Demographics
NPI:1669476271
Name:ELKSNIS, STEPHEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:ELKSNIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11137
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25339-1137
Mailing Address - Country:US
Mailing Address - Phone:304-344-3457
Mailing Address - Fax:304-344-3480
Practice Address - Street 1:1120 KANAWHA BLVD E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2400
Practice Address - Country:US
Practice Address - Phone:304-344-3457
Practice Address - Fax:304-344-3480
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV158042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV020011800OtherFEDERAL BLACK LUNG
WV550516458OtherACORDIA NATIONAL PEIA
KY64699069Medicaid
WV0130753OtherUMWA
OH0855392Medicaid
WV151237200OtherUS DOL & US POSTAL COMP
WVF23074OtherBRICKSTREET INSURANCE
WV14193OtherCARELINK & CARELINK PEIA
WV0119093000Medicaid
WV55-0516458OtherGROUP FEIN #
WV001718804OtherFREEDOM BLUE & MS BCBS
WV550516458Medicaid
WV14175Medicaid
WVEL0884948-49;-6221Medicare PIN
WV001718804OtherFREEDOM BLUE & MS BCBS
WV020011800OtherFEDERAL BLACK LUNG
WV0119093000Medicaid