Provider Demographics
NPI:1780640268
Name:ODONNELL, ELAINE A (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:A
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 E DRINKER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-2469
Mailing Address - Country:US
Mailing Address - Phone:570-348-1757
Mailing Address - Fax:570-348-6721
Practice Address - Street 1:414 E DRINKER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-2469
Practice Address - Country:US
Practice Address - Phone:570-348-1757
Practice Address - Fax:570-348-6721
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002764213ES0103X, 213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001176279Medicaid
PA480033356OtherRAILROAD MEDICARE
PA001176279Medicaid
PA566153Medicare PIN
PA480033356OtherRAILROAD MEDICARE