Provider Demographics
NPI:1154438190
Name:KARKALAS, ELIAS A (MD)
Entity type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:A
Last Name:KARKALAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 FLINTLOCK LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-2647
Mailing Address - Country:US
Mailing Address - Phone:610-324-6117
Mailing Address - Fax:
Practice Address - Street 1:80 FLINTLOCK LN
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2647
Practice Address - Country:US
Practice Address - Phone:610-324-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025225E207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA183162QRSMedicare ID - Type Unspecified
PAB40831Medicare UPIN