Provider Demographics
NPI:1699463877
Name:CONSTANTINESCU, ELAINE (RMA, PBT(ASCP))
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:
Last Name:CONSTANTINESCU
Suffix:
Gender:F
Credentials:RMA, PBT(ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HAMMON DR
Mailing Address - Street 2:
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-5102
Mailing Address - Country:US
Mailing Address - Phone:208-249-7182
Mailing Address - Fax:208-742-1891
Practice Address - Street 1:2 HAMMON DR
Practice Address - Street 2:
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-5102
Practice Address - Country:US
Practice Address - Phone:208-249-7182
Practice Address - Fax:208-742-1891
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID58191202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology