Organization
ZIPPORAH ELAN
Active
Organization
ZIPPORAH ELAN
Active
Other names
Home Prostheticare
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY MICHAEL ELAN CP (VICE PRESIDENT PROSTHETIST)
(410) 486-4796
Entity
Organization
Contact information
Practice address
301 REISTERSTOWN RD, FL 1, BALTIMORE, MD 21208-5313
(410) 486-4796
(410) 486-9749
Mailing address
301 REISTERSTOWN RD, FL 1, BALTIMORE, MD 21208-5313
(410) 486-4796
(410) 486-9749
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
CP2000
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1028269
ACM
—
05
—
501038100
—
MD
01
—
58080901
BCBS
—
01
—
59336
AMERIGROUP
—
01
—
63340001
BCBS
—
01
—
Y120
BCBS
—
Enumeration date
06/04/2007
Last updated
06/17/2008
Update your record
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