Healthcare Provider Details

I. General information

NPI: 1952355745
Provider Name (Legal Business Name): ELAINE S BLUE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 7TH ST SUITE 2C
PENNSBURG PA
18073-1512
US

IV. Provider business mailing address

101 W 7TH ST SUITE 2C
PENNSBURG PA
18073-1512
US

V. Phone/Fax

Practice location:
  • Phone: 215-679-9321
  • Fax:
Mailing address:
  • Phone: 215-679-9321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD417809
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: