MEDICARE: ELLIOTT MCPHERSON PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	C5-0000698	DE

General Provider Information

NPI Number	:	1881653475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLIOTT MCPHERSON PA

Provider Business Mailing Address
First Line	:	245 N 15TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1101
Country	:	US
Telephone Number	:	215-762-4312
Fax Number	:	215-762-8656

Provider Business Practice Location Address
First Line	:	245 N 15TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1101
Country	:	US
Telephone Number	:	215-762-4312
Fax Number	:	215-762-8656

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	11/21/2023

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Directions to “ ELLIOTT MCPHERSON PA” Practice Location

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