Healthcare Provider Details

I. General information

NPI: 1740393206
Provider Name (Legal Business Name): ELENA DLUGACH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 MALLARD ST
GREENVILLE SC
29601-4046
US

IV. Provider business mailing address

124 MALLARD ST
GREENVILLE SC
29601-4046
US

V. Phone/Fax

Practice location:
  • Phone: 864-241-1040
  • Fax: 864-241-1049
Mailing address:
  • Phone: 864-241-1040
  • Fax: 864-241-1049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number015623
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number015623
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number31140
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number31140
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: