Provider Demographics
NPI:1841225554
Name:ELMORE, DILLARD (DO, MBA)
Entity type:Individual
Prefix:DR
First Name:DILLARD
Middle Name:
Last Name:ELMORE
Suffix:
Gender:M
Credentials:DO, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 MIDDLE HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4822
Mailing Address - Country:US
Mailing Address - Phone:516-410-7720
Mailing Address - Fax:
Practice Address - Street 1:280 MIDDLE HOLLAND RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4822
Practice Address - Country:US
Practice Address - Phone:516-410-7720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018488207Q00000X
MI5101028427207Q00000X
NC2021-03386207Q00000X
MDH0086274207Q00000X
GA91055207Q00000X
OH34.017812207Q00000X
NY237999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02807596Medicaid
NYA400043046Medicare PIN