Provider Demographics
NPI:1881689297
Name:ELDER, JAY E (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:E
Last Name:ELDER
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 1:204 PINE ST
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-1929
Mailing Address - Country:US
Mailing Address - Phone:814-938-5204
Mailing Address - Fax:
Practice Address - Street 1:204 PINE ST
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-1929
Practice Address - Country:US
Practice Address - Phone:814-938-5204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035671E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001044618-0003Medicaid
PAC31594Medicare UPIN
PA001044618-0003Medicaid