Provider Demographics
NPI:1427058098
Name:DAVIDSON, ELANA (PA C)
Entity type:Individual
Prefix:
First Name:ELANA
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HOSPITAL DR FL 3
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-6601
Mailing Address - Country:US
Mailing Address - Phone:413-535-4757
Mailing Address - Fax:413-535-4758
Practice Address - Street 1:2 HOSPITAL DR
Practice Address - Street 2:SUITE 203
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-6632
Practice Address - Country:US
Practice Address - Phone:413-540-5048
Practice Address - Fax:413-540-5049
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1031363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
043202198OtherCBA
043202198OtherGREAT WEST HEALTH PLAN
000954OtherCONNECTICARE OF MA
043202198OtherBEECH STREET
043202198OtherGREAT WEST HEALTH PLAN
000954OtherCONNECTICARE OF MA