Provider Demographics
NPI:1245250661
Name:ELVIN, DAVID M (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:ELVIN
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 1:237 HAMPSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1306
Mailing Address - Country:US
Mailing Address - Phone:617-575-5550
Mailing Address - Fax:
Practice Address - Street 1:237 HAMPSHIRE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1306
Practice Address - Country:US
Practice Address - Phone:617-575-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213950207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0032463OtherNHP
MA110241017OtherMEDICARE RAIL ROAD
MA693309OtherHPHC
MA213950OtherTUFTS HELATH PLAN
MAELJ25160OtherBCBS
MA3020405OtherATENA
MA49-00017OtherEVERCARE
MA975458OtherNETWORK HEALTH
MA2020530Medicaid
MA2020530Medicaid