Healthcare Provider Details

I. General information

NPI: 1295063568
Provider Name (Legal Business Name): ERIC E. ELBERT B.A., M.A., NBC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7342 BELL CREEK RD
MECHANICSVILLE VA
23111-3545
US

IV. Provider business mailing address

7342 BELL CREEK RD
MECHANICSVILLE VA
23111-3545
US

V. Phone/Fax

Practice location:
  • Phone: 804-559-4625
  • Fax: 804-559-4627
Mailing address:
  • Phone: 804-559-4625
  • Fax: 804-559-4627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2101 001458
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: