=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376702928
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN MARC ELLIOTT M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2008
-----------------------------------------------------
Last Update Date | 01/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 DOWNER AVE
-----------------------------------------------------
City | SCARSDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10583-4904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 862-309-6096
-----------------------------------------------------
Fax | 614-455-9796
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 DOWNER AVE
-----------------------------------------------------
City | SCARSDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10583-4904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 862-309-6096
-----------------------------------------------------
Fax | 614-455-9796
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number | 251161
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------