MEDICARE: STEPHANIE M ELSEN M.D.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	175064	NY
2	207R00000X	Internal Medicine Physician	142718	FL
3	207R00000X	Internal Medicine Physician	175064	NY
4	207R00000X	Internal Medicine Physician	ME142718	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00132274	OTHER	NY	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1700964723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE M ELSEN M.D.

Provider Business Mailing Address
First Line	:	1402 NE 34TH ST UNIT A
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334-4538
Country	:	US
Telephone Number	:	585-743-7013
Fax Number	:

Provider Business Practice Location Address
First Line	:	2007 PALM BEACH LAKES BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6501
Country	:	US
Telephone Number	:	561-420-8555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	06/14/2022

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308