Provider Demographics
NPI:1932514486
Name:JONES, ELYSE KRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:KRISTINE
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:KRISTINE
Other - Last Name:PAGERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:501 CETRONIA RD STE 115
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9569
Mailing Address - Country:US
Mailing Address - Phone:484-426-2468
Mailing Address - Fax:
Practice Address - Street 1:14 MEDICAL PARK, STE 400
Practice Address - Street 2:CHILDREN'S HOSPITAL OUTPATIENT CENTER
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-6155
Practice Address - Fax:803-434-6979
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD461365208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics