Provider Demographics
NPI:1386371946
Name:ELDER, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:ELDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 COVE POINT RD
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-4623
Mailing Address - Country:US
Mailing Address - Phone:443-624-4889
Mailing Address - Fax:
Practice Address - Street 1:2709 COVE POINT RD
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657-4623
Practice Address - Country:US
Practice Address - Phone:443-624-4889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer