Provider Demographics
NPI:1881664134
Name:NAME, ELIAS (MD)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:
Last Name:NAME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 MAPLE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-5140
Mailing Address - Country:US
Mailing Address - Phone:413-420-2200
Mailing Address - Fax:413-539-9473
Practice Address - Street 1:444 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1969
Practice Address - Country:US
Practice Address - Phone:413-594-3111
Practice Address - Fax:413-598-7115
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212968207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA971811OtherNETWORK HEALTH
MA0032451OtherMEIGHBORHOOD HEALTH PLAN
MA28194OtherBOSTON HEALTH NET
MANAJ27356OtherBLUE CROSS BLUE SHIELD
MA28194OtherBOSTON HEALTH NET
MAA36151Medicare ID - Type UnspecifiedMEDICARE NUMBER