Basic Information
| Provider Information | |||||||||
| NPI: | 1508876889 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELIAS | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 EAST PARK AVENUE | ||||||||
| Address2: | |||||||||
| City: | STATE COLLEGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142784851 | ||||||||
| FaxNumber: | 8142317138 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 EAST PARK AVENUE | ||||||||
| Address2: | |||||||||
| City: | STATE COLLEGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142784851 | ||||||||
| FaxNumber: | 8142317138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 11/14/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | OS-010510-L | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000561357 | 01 | PA | BLUE CROSS | OTHER | 0018035480003 | 05 | PA | MEDICAID |