Individual
ELTON JOHN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4641 ROOSEVELT BLVD, PHILA, PA 19124-2343
(215) 831-4600
Mailing address
4641 E ROOSEVELT BLVD, PHILA, PA 19124-2343
(215) 831-4600
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
0101259244
VA
2084P0800X
Psychiatry Physician
036140146
IL
2084P0800X
Psychiatry Physician
25MA08836800
NJ
2084P0800X
Psychiatry Physician
C1-0008215
DE
2084P0800X
Psychiatry Physician
MD425154
PA
2084P0804X
Child & Adolescent Psychiatry Physician
0101259244
VA
2084P0804X
Child & Adolescent Psychiatry Physician
25MA08836800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD425154
LICENSE NUMBER
PA
Enumeration date
05/18/2006
Last updated
10/27/2025
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