Provider Demographics
NPI:1154715050
Name:ELMAN, DYLAN PETER (DO)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:PETER
Last Name:ELMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ATWELL RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1301
Mailing Address - Country:US
Mailing Address - Phone:607-431-5290
Mailing Address - Fax:607-431-5367
Practice Address - Street 1:1 FOXCARE DR
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2099
Practice Address - Country:US
Practice Address - Phone:607-431-5290
Practice Address - Fax:607-431-5439
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292663-1207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program