Provider Demographics
NPI:1679506950
Name:ELCOCK-MESSAM, JUNE E (MD)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:E
Last Name:ELCOCK-MESSAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MOORE RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-7049
Mailing Address - Country:US
Mailing Address - Phone:610-565-3336
Mailing Address - Fax:484-361-5938
Practice Address - Street 1:401 MOORE RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:PA
Practice Address - Zip Code:19086-7049
Practice Address - Country:US
Practice Address - Phone:610-565-3336
Practice Address - Fax:484-361-5938
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071892-L261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH24667Medicare UPIN