NPIMap

Organization Active NPI

Elan Plastic Surgery PC

  • Plastic Surgery Physician
  • Frederick, MD
National Provider Identifier
1063783660
Registry record updated Feb 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
D0037204 Issued in MD
Legal business name
ELAN PLASTIC SURGERY PC
Practice address
15 Wormans Mill CT Ste L-M
Frederick, MD 21701-3019
Phone
(301) 698-2400
Fax
(301) 698-2460
NPI assigned
Jan 13, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Paige Smith
Title
Credentialing Manager
Phone
(301) 509-4091

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X D0037204 MD Primary

Addresses

Primary practice location

15 Wormans Mill CT Ste L-M
Frederick, MD 21701-3019

Mailing address

15 Wormans Mill CT Ste L-M
Frederick, MD 21701-3019
Phone (301) 698-2400

Other identifiers 1

IdentifierTypeStateIssuer
V6710001OtherMDCAREFIRST BLUECROSS BLUESHIELD

National Provider Directory

National Provider Directory

Locations

1560 Opossumtown Pike
Ste A26
Frederick, MD 21702
Phone (301) 698-2400

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613088000000",
    "number": "1063783660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 WORMANS MILL CT STE L-M",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217013019",
            "telephone_number": "301-698-2400",
            "fax_number": "301-698-2460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 WORMANS MILL CT STE L-M",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217013019",
            "telephone_number": "301-698-2400",
            "fax_number": "301-698-2460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELAN PLASTIC SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-13",
        "last_updated": "2021-02-12",
        "certification_date": "2021-02-12",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "PAIGE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "301-509-4091"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "MD",
            "license": "D0037204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUECROSS BLUESHIELD",
            "identifier": "V6710001",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.