Provider Demographics
NPI:1093178253
Name:ELVIS, MBACHECK IX
Entity type:Individual
Prefix:MR
First Name:MBACHECK
Middle Name:
Last Name:ELVIS
Suffix:IX
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MBACHECK
Other - Middle Name:
Other - Last Name:ELVIS
Other - Suffix:IX
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9003 BRIGHTLEA CT
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2844
Mailing Address - Country:US
Mailing Address - Phone:240-467-7341
Mailing Address - Fax:
Practice Address - Street 1:9003 BRIGHTLEA CT
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706
Practice Address - Country:US
Practice Address - Phone:240-467-7341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDHHA11949Medicare Oscar/Certification