Individual provider Active NPI

Marsha Ayzen Elkhunovich, M.D.

  • Pediatrics Physician
  • Philadelphia, PA
National Provider Identifier
1710178934
Registry record updated Jul 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MT188294 Issued in PA
Practice address
34TH & Civic Center Blvd
Children's Hospital of Philadelphia
Philadelphia, PA 19104-4399
Phone
(215) 590-1000
Fax
(215) 590-2204
NPI assigned
Aug 5, 2007
Last updated
Jul 1, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MT188294 PA Primary

Addresses

Primary practice location

34TH & Civic Center Blvd
Children's Hospital of Philadelphia
Philadelphia, PA 19104-4399

Mailing address

3535 Market St
12TH Floor, Suite 1220 - Chop Dept of Msa
Philadelphia, PA 19104-3309
Phone (215) 590-4670

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110211000789 CA Practitioner - Emergency Medicine 5890975544 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MT188294PAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Hospital Los Angeles Medical Group, Inc. Pediatrics CurrentSince May 1, 2016 Accepting new patients
Childrens Hospital of Los Angeles Past Accepting new patients
Children's Hospital Los Angeles Past Accepting new patients

Locations

3701 Wilshire Blvd
Ste 600
Los Angeles, CA 90010
Phone (323) 361-3550

4650 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 361-2122

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467331200000",
    "number": "1710178934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 MARKET ST",
            "address_2": "12TH FLOOR, SUITE 1220 - CHOP DEPT OF MSA",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191043309",
            "telephone_number": "215-590-4670",
            "fax_number": "215-590-2204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34TH & CIVIC CENTER BLVD",
            "address_2": "CHILDREN'S HOSPITAL OF PHILADELPHIA",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044399",
            "telephone_number": "215-590-1000",
            "fax_number": "215-590-2204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELKHUNOVICH",
        "first_name": "MARSHA",
        "middle_name": "AYZEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-05",
        "last_updated": "2016-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MT188294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.