Provider Demographics
NPI:1154541712
Name:DELBUSTO, ELENA T (MD)
Entity type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:T
Last Name:DELBUSTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:349 W. LANCASTER AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041
Mailing Address - Country:US
Mailing Address - Phone:215-565-1005
Mailing Address - Fax:215-494-1070
Practice Address - Street 1:349 W. LANCASTER AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041
Practice Address - Country:US
Practice Address - Phone:215-565-1005
Practice Address - Fax:215-494-1070
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4323002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022027140001Medicaid
PA132489P0TMedicare PIN