Healthcare Provider Details

I. General information

NPI: 1124144431
Provider Name (Legal Business Name): ELIJAH TELFARE P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VINCENT TELFARE PA

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LILLY RD NE SUITE 100
OLYMPIA WA
98506-5195
US

IV. Provider business mailing address

PO BOX 368
OLYMPIA WA
98507-0368
US

V. Phone/Fax

Practice location:
  • Phone: 360-491-4211
  • Fax: 360-493-0407
Mailing address:
  • Phone: 360-491-8439
  • Fax: 360-491-6328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA10002241
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: