Basic Information
| Provider Information | |||||||||
| NPI: | 1649290784 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCELWEE | ||||||||
| FirstName: | EUGENE | ||||||||
| MiddleName: | T. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 BULLDOG BLVD STE 202 | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329013188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217257225 | ||||||||
| FaxNumber: | 3213080635 | ||||||||
| Practice Location | |||||||||
| Address1: | 1344 S APOLLO BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329013185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217252225 | ||||||||
| FaxNumber: | 3213080635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 02/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 02/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS006648L | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 2083X0100X | OS18207 | FL | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0277110000 | 01 | PA | AMERIHEALTH 65 PA | OTHER | 188404 | 01 | PA | UNISON-WMG | OTHER | 20057319 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 2161250 | 01 | PA | MAMSI-WMG | OTHER | 5998517 | 01 | PA | AETNA | OTHER | 889362 | 01 | MD | CAREFIRST MD BCBS | OTHER | 50062684 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 997600 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 101393916 | 05 | PA | MEDICAID | 100460 | 01 | PA | GEISINGER | OTHER | 1544893 | 01 | PA | GATEWAY-WMG | OTHER | 205438 | 01 | PA | JOHNS HOPKINS | OTHER | 30096358 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER |