Healthcare Provider Details

I. General information

NPI: 1720398225
Provider Name (Legal Business Name): MR. STEVEN ELEK IV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 05/03/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HEALTH CLINIC PATUXENT RIVER 47149 BUSE ROAD BLDG. 1370
PATUXENT RIVER MD
20670
US

IV. Provider business mailing address

NAVAL HEALTH CLINIC PATUXENT RIVER 47149 BUSE ROAD BLDG. 1370
PATUXENT RIVER MD
20670
US

V. Phone/Fax

Practice location:
  • Phone: 301-995-2615
  • Fax:
Mailing address:
  • Phone: 301-995-2615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102203038
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0116023238
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: