Basic Information
| Provider Information | |||||||||
| NPI: | 1528016664 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELDER | ||||||||
| FirstName: | KERREN | ||||||||
| MiddleName: | HARRY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | ELDER | ||||||||
| OtherFirstName: | KERREN | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3211 SHANNON RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277076322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002914020 | ||||||||
| FaxNumber: | 9194197247 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 TILGHMAN DR | ||||||||
| Address2: | |||||||||
| City: | DUNN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283345510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002914020 | ||||||||
| FaxNumber: | 9194197247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 08/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 200000781 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207P00000X | 27445 | WV | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 200000781 | NC | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.