Provider Demographics
NPI:1104104280
Name:ELAN REISIN MD FACS LLC
Entity type:Organization
Organization Name:ELAN REISIN MD FACS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REISIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-560-5111
Mailing Address - Street 1:6420 ROCKLEDGE DR
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-7837
Mailing Address - Country:US
Mailing Address - Phone:240-560-5111
Mailing Address - Fax:240-560-5110
Practice Address - Street 1:6420 ROCKLEDGE DR
Practice Address - Street 2:SUITE 2300
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-7837
Practice Address - Country:US
Practice Address - Phone:240-560-5111
Practice Address - Fax:240-560-5110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-24
Last Update Date:2011-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0101239193208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty