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General NPI Number Information
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NPI Number | 1821223413
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Entity Type | Individual
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Provider Name | JUSTIN LEE ELDER D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/26/2009
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 17005 OLD ORCHARD RD
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City | LEWES
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State | DE
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Zip | 19958-4828
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Country | US
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Telephone | 302-703-4025
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Fax | 302-703-4027
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Provider Business Mailing Address
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Address Line | 17005 OLD ORCHARD RD
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City | LEWES
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State | DE
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Zip | 19958-4828
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Country | US
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Telephone | 302-703-4025
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Fax | 302-703-4027
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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 | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | AS2593778E50
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | C20010095
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License Number State | DE
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