Individual
DR. ELAINE DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
160 LINCOLN STREET, MONTCLAIR, NJ 07042-4432
(973) 744-0528
Mailing address
160 LINCOLN ST, MONTCLAIR, NJ 07042-4432
(973) 744-0528
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MA05226500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA05226500
LICENSE
NJ
01
—
31D0896592
CLIA
NJ
01
—
D04980000
CDS
NJ
01
—
OK1590
HEALTHNET
NJ
01
—
P375146
OXFORD
NJ
Enumeration date
10/17/2006
Last updated
03/07/2023
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