Provider Demographics
NPI:1811910623
Name:ELDER, DEMIAN (MD)
Entity type:Individual
Prefix:
First Name:DEMIAN
Middle Name:
Last Name:ELDER
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 1:901 MARKET ST STE 500
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3144
Mailing Address - Country:US
Mailing Address - Phone:215-845-4917
Mailing Address - Fax:
Practice Address - Street 1:901 MARKET ST STE 500
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-3144
Practice Address - Country:US
Practice Address - Phone:215-845-4917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD462992207R00000X
NJMAO74370207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD462992OtherPA LICENSE
CA00C533260Medicaid
CAAT297ZMedicare PIN
NJH65079Medicare UPIN
CA00C533260Medicaid