Healthcare Provider Details

I. General information

NPI: 1851882435
Provider Name (Legal Business Name): ELSA MONTOYA AGUILAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2018
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 LONDONDERRY RD STE 109
HARRISBURG PA
17109-5329
US

IV. Provider business mailing address

4310 LONDONDERRY RD STE 109
HARRISBURG PA
17109-5329
US

V. Phone/Fax

Practice location:
  • Phone: 717-988-0611
  • Fax:
Mailing address:
  • Phone: 717-988-0611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT214968
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberMD475857
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: