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General NPI Number Information
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NPI Number | 1649514811
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Entity Type | Individual
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Provider Name | KEITH STACY ELSNER PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/12/2012
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Last Update Date | 12/09/2019
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Provider Practice Location Address
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Address Line | 230 W WASHINGTON SQ STE 102
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City | PHILADELPHIA
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State | PA
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Zip | 19106-3500
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Country | US
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Telephone | 215-829-3985
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Fax | 215-829-3340
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Provider Business Mailing Address
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Address Line | 230 W WASHINGTON SQ STE 102
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City | PHILADELPHIA
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State | PA
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Zip | 19106-3500
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Country | US
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Telephone | 215-829-3985
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Fax | 215-829-3340
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C5-0000851
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA055901
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License Number State | PA
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