Provider Demographics
NPI: | 1306810999 |
---|---|
Name: | ELKO, BARBARA ANNE C (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | BARBARA |
Middle Name: | ANNE C |
Last Name: | ELKO |
Suffix: | |
Gender: | F |
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: | 5000 COX RD |
Mailing Address - Street 2: | |
Mailing Address - City: | GLEN ALLEN |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23060-9263 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 119 SHOEMAKER RD |
Practice Address - Street 2: | |
Practice Address - City: | POTTSTOWN |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19464-6429 |
Practice Address - Country: | US |
Practice Address - Phone: | 610-427-4919 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-02-13 |
Last Update Date: | 2022-07-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MD069540L | 207R00000X, 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 001899585 | Medicaid | |
PA | 232359401 | Other | MAIN LINE HEALTHCARE |
H13371 | Medicare UPIN | ||
PA | 036936 | Medicare PIN | |
PA | 036936N2P | Medicare ID - Type Unspecified |