1356443774 NPI number — DR. DAVID HENRY ELFENBEIN M.D.

Table of content: DR. DAVID HENRY ELFENBEIN M.D. (NPI 1356443774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356443774 NPI number — DR. DAVID HENRY ELFENBEIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELFENBEIN
Provider First Name:
DAVID
Provider Middle Name:
HENRY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356443774
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1627
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESTED BUTTE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81224-1627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-672-1980
Provider Business Mailing Address Fax Number:
970-817-2112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 ELK AVE STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESTED BUTTE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81224-5433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-672-1980
Provider Business Practice Location Address Fax Number:
970-817-2112
Provider Enumeration Date:
09/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  038451 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 56343 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2355159 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1942708326 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 038451 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010038451CT01 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1967516 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2963655002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2104370 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2V2654 . This is a "HLTHNET OF THE NORTHEAST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001384510 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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