Provider Demographics
NPI:1063563252
Name:TROGDON, ELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:TROGDON
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 1:5912 TALL BRANCHES PASS
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1691
Mailing Address - Country:US
Mailing Address - Phone:410-707-6069
Mailing Address - Fax:443-533-5987
Practice Address - Street 1:5912 TALL BRANCHES PASS
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1691
Practice Address - Country:US
Practice Address - Phone:410-707-6069
Practice Address - Fax:443-533-5987
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO35166208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics