Provider Demographics
NPI:1770639569
Name:DAVID ELBAUM, DO, LLC
Entity Type:Organization
Organization Name:DAVID ELBAUM, DO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-285-3865
Mailing Address - Street 1:115 SUMMIT LN
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2918
Mailing Address - Country:US
Mailing Address - Phone:610-664-1465
Mailing Address - Fax:610-664-1466
Practice Address - Street 1:115 SUMMIT LN
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2918
Practice Address - Country:US
Practice Address - Phone:610-664-1465
Practice Address - Fax:610-664-1466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003661L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D98792Medicare UPIN