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General NPI Number Information
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NPI Number | 1265634190
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Entity Type | Organization
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Legal Business Name | ZIPPORAH ELAN
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 301 REISTERSTOWN RD FL 1
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City | BALTIMORE
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State | MD
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Zip | 21208-5313
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Country | US
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Telephone | 410-486-4796
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Fax | 410-486-9749
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Provider Business Mailing Address
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Address Line | 301 REISTERSTOWN RD FL 1
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City | BALTIMORE
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State | MD
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Zip | 21208-5313
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Country | US
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Telephone | 410-486-4796
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Fax | 410-486-9749
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Authorized Official
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Title or Position | VICE PRESIDENT PROSTHETIST
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Name | MR. TERRY MICHAEL ELAN
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Credential | CP
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Telephone | 410-486-4796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | CP2000
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License Number State | VA
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