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General NPI Number Information
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NPI Number | 1336233931
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Entity Type | Individual
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Provider Name | MARK E. ELKINSON OD PA
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 11/09/2012
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Provider Practice Location Address
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Address Line | 200 GORHAM RD SUITE 940
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2409
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Country | US
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Telephone | 207-761-9054
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Fax | 207-879-9003
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Provider Business Mailing Address
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Address Line | 200 GORHAM RD SUITE 940
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2409
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Country | US
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Telephone | 207-761-9054
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Fax | 207-879-9003
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT758
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License Number State | ME
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