Provider Demographics
NPI:1285614099
Name:ELPERN, DAVID JOEL (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOEL
Last Name:ELPERN
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 1:12 MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01267
Mailing Address - Country:US
Mailing Address - Phone:413-458-2800
Mailing Address - Fax:413-458-4224
Practice Address - Street 1:12 MEADOW ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:MA
Practice Address - Zip Code:01267
Practice Address - Country:US
Practice Address - Phone:413-458-2800
Practice Address - Fax:413-458-4224
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78145207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3114139Medicaid
VTOVN0704Medicaid
MA078145OtherTUFTS
J14161Medicare PIN
C97383Medicare UPIN
MA3114139Medicaid