Provider Demographics
NPI:1720064983
Name:ELDER, ANN MARIA LABAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN MARIA
Middle Name:LABAR
Last Name:ELDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 WORCESTER ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1045
Mailing Address - Country:US
Mailing Address - Phone:413-543-6820
Mailing Address - Fax:413-543-7962
Practice Address - Street 1:222 STATE ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056
Practice Address - Country:US
Practice Address - Phone:413-308-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81132207R00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008016397Medicaid
NY02639072Medicaid
MA110056124AMedicaid
MAA20336Medicare PIN
MA110056124AMedicaid