Provider Demographics
NPI:1841270949
Name:ELLIOTT, PATRICK L (DO)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:L
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:204 E CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-1730
Mailing Address - Country:US
Mailing Address - Phone:610-521-4833
Mailing Address - Fax:610-521-2651
Practice Address - Street 1:204 E CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-1730
Practice Address - Country:US
Practice Address - Phone:610-521-4833
Practice Address - Fax:610-521-2651
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009816L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G63154Medicare UPIN
PA005239Medicare PIN
PA0018566860001Medicare ID - Type Unspecified