Healthcare Provider Details

I. General information

NPI: 1477197457
Provider Name (Legal Business Name): ELDER & ASSOCIATES ENT-FACIAL PLASTIC SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17005 OLD ORCHARD RD
LEWES DE
19958-4828
US

IV. Provider business mailing address

17005 OLD ORCHARD RD
LEWES DE
19958-4828
US

V. Phone/Fax

Practice location:
  • Phone: 717-269-3106
  • Fax: 302-336-4328
Mailing address:
  • Phone: 717-269-3106
  • Fax: 302-336-4328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN ELDER
Title or Position: PRESIDENT
Credential: DO
Phone: 717-269-3106