Healthcare Provider Details

I. General information

NPI: 1487620423
Provider Name (Legal Business Name): ELSA ISABEL CORREA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 MAIN STREET
REISTERSTOWN MD
21136-1213
US

IV. Provider business mailing address

217 MAIN ST
REISTERSTOWN MD
21136-1213
US

V. Phone/Fax

Practice location:
  • Phone: 410-833-0580
  • Fax: 410-833-8604
Mailing address:
  • Phone: 410-833-0580
  • Fax: 410-833-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0020136
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: