Provider Demographics
NPI:1720023567
Name:ELON, REBECCA DAVIS (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DAVIS
Last Name:ELON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6701 N. CHARLES STREET
Mailing Address - Street 2:SUITE 4105
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:443-849-3184
Mailing Address - Fax:443-849-3182
Practice Address - Street 1:6334 CEDAR LANE
Practice Address - Street 2:SUITE 103
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:443-849-3184
Practice Address - Fax:410-531-2608
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2010-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0041955207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
263108258OtherTRICARE NORTH
MD308481700Medicaid
P516-0002OtherCAREFIRST BCBS OF DC
04-60878OtherEVERCARE
523947-06OtherCAREFIRST BCBS OF MD
B22526Medicare UPIN
P00690840Medicare PIN
131817ZAG0Medicare PIN
523947-06OtherCAREFIRST BCBS OF MD