Healthcare Provider Details

I. General information

NPI: 1306835145
Provider Name (Legal Business Name): ELIE PAUL ELOVIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 MILL ST
RENO NV
89502-1479
US

IV. Provider business mailing address

101 E OLNEY AVENUE SUITE 400
PHILADELPHIA PA
19120-2421
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-3500
  • Fax: 775-982-3665
Mailing address:
  • Phone: 215-456-7000
  • Fax: 215-456-5926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number16186
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MA05971300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD032799E
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number7277536-1205
License Number StateUT
# 5
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35134992
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: