Healthcare Provider Details

I. General information

NPI: 1497508543
Provider Name (Legal Business Name): ELSA S TABREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32060 LONG NECK RD
MILLSBORO DE
19966-6228
US

IV. Provider business mailing address

424 SAVANNAH RD
LEWES DE
19958-1462
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-3150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC7-0018672
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: