Provider Demographics
NPI:1851882435
Name:MONTOYA AGUILAR, ELSA
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:
Last Name:MONTOYA AGUILAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 LONDONDERRY RD STE 109
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5329
Mailing Address - Country:US
Mailing Address - Phone:717-988-0611
Mailing Address - Fax:
Practice Address - Street 1:4310 LONDONDERRY RD STE 109
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5329
Practice Address - Country:US
Practice Address - Phone:717-988-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-19
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT214968207Q00000X
PAMD475857207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine