Provider Demographics
NPI:1184601692
Name:ELUM, EDGAR C (MD)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:C
Last Name:ELUM
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 1:1662 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205
Mailing Address - Country:US
Mailing Address - Phone:518-869-9692
Mailing Address - Fax:518-869-7220
Practice Address - Street 1:1662 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205
Practice Address - Country:US
Practice Address - Phone:518-869-9692
Practice Address - Fax:518-869-7220
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111259207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000411153008OtherBLUE SHIELD OF NENY
10000574OtherCDPHP
11742OtherMVP
2594608OtherGHI
115780OtherMVP
141752151OtherUNITED HEALTH CARE
000411153007OtherBLUE SHIELD OF NENY
141659448OtherSTATEWIDE PPO
24S111OtherBLUE CROSS BLUE SHIELD
55333OtherGHI HMO
141659448OtherUNITED HEALTH CARE
141752151OtherSTATEWIDE PPO
24S113OtherBLUE CROSS BLUE SHIELD
24S112OtherBLUE CROSS BLUE SHIELD
4396748OtherAETNA
115780OtherMVP