Healthcare Provider Details

I. General information

NPI: 1619840733
Provider Name (Legal Business Name): ELMAN RETINA GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11055 LITTLE PATUXENT PKWY STE 105
COLUMBIA MD
21044-2908
US

IV. Provider business mailing address

9114 PHILADELPHIA RD STE 310
BALTIMORE MD
21237-4350
US

V. Phone/Fax

Practice location:
  • Phone: 410-686-3000
  • Fax:
Mailing address:
  • Phone: 410-686-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY MUNKER
Title or Position: BILLING MANAGER
Credential:
Phone: 410-686-3000