Provider Demographics
NPI:1902893787
Name:MCDONALD, ELANA (MD)
Entity Type:Individual
Prefix:
First Name:ELANA
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELANA
Other - Middle Name:O
Other - Last Name:MILES-MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3380 MEMPHIS ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4510
Mailing Address - Country:US
Mailing Address - Phone:215-426-5566
Mailing Address - Fax:215-739-7304
Practice Address - Street 1:3380 MEMPHIS ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4510
Practice Address - Country:US
Practice Address - Phone:215-426-5566
Practice Address - Fax:215-739-7304
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421148208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics