Basic Information
| Provider Information | |||||||||
| NPI: | 1043433816 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOLSOM ELDER | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | ANTOINETTE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FOLSOM | ||||||||
| OtherFirstName: | MICHELLE | ||||||||
| OtherMiddleName: | ANTOINETTE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 110 HOSPITAL RD | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | PRINCE FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206784019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105354488 | ||||||||
| FaxNumber: | 4105356131 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 HOSPITAL RD | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | PRINCE FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206784019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105354488 | ||||||||
| FaxNumber: | 4105356131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 01/31/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D0067487 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.