Provider Demographics
NPI:1316928344
Name:ELWOOD, NANCY SUE (MD)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:SUE
Last Name:ELWOOD
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 1:4315 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2503
Mailing Address - Country:US
Mailing Address - Phone:304-926-8080
Mailing Address - Fax:304-586-1301
Practice Address - Street 1:4315 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2503
Practice Address - Country:US
Practice Address - Phone:304-926-8080
Practice Address - Fax:304-926-8083
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA053140207Q00000X
WV23395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV0542AOtherMEDICARE PIN
WV1316928344Medicaid
WV4259261Medicare PIN