Individual
COREY ELMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5501 OLD YORK RD STE 1, PHILADELPHIA, PA 19141-3098
(215) 456-7890
Mailing address
4924 JACKSON DR, BROOKHAVEN, PA 19015-1008
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1165473
PA
Other
Enumeration date
11/13/2019
Last updated
11/13/2019
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