Provider Demographics
NPI:1770530404
Name:FOX, ELWOOD J (DO)
Entity type:Individual
Prefix:
First Name:ELWOOD
Middle Name:J
Last Name:FOX
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:59 SLEEPY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-2563
Mailing Address - Country:US
Mailing Address - Phone:207-857-9311
Mailing Address - Fax:207-857-9473
Practice Address - Street 1:2 CHABOT ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4817
Practice Address - Country:US
Practice Address - Phone:207-857-9311
Practice Address - Fax:207-857-9473
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME1709207R00000X, 2081P2900X, 2081S0010X, 208100000X
MA152398207R00000X, 208100000X
TN3552208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEG41571Medicare UPIN
MEP00458148Medicare PIN
MEMM889804Medicare PIN
MEMM889803Medicare PIN