Provider Demographics
NPI:1124053681
Name:ELBAUM, DAVID M (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:ELBAUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:115 SUMMIT LN
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2918
Mailing Address - Country:US
Mailing Address - Phone:610-664-1465
Mailing Address - Fax:610-664-1466
Practice Address - Street 1:175 CROSS KEYS RD
Practice Address - Street 2:300A
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-9263
Practice Address - Country:US
Practice Address - Phone:856-767-0077
Practice Address - Fax:856-767-6102
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS003661L207RC0000X
NJ25MB03351700207RC0000X
AZ3639207RC0000X
NY200056207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6847111OtherAETNA
PA0500861000OtherINDEPENDENCE BLUE CROSS
D98792Medicare UPIN
NJ638680Medicare PIN