Provider Demographics
NPI:1437241387
Name:ELWELL, ROBERT SCOTT (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MISS
First Name:ROBERT
Middle Name:SCOTT
Last Name:ELWELL
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
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Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:CASTILE
Mailing Address - State:NY
Mailing Address - Zip Code:14427-0505
Mailing Address - Country:US
Mailing Address - Phone:585-493-2587
Mailing Address - Fax:585-493-5580
Practice Address - Street 1:5596 ROUTE 19A
Practice Address - Street 2:
Practice Address - City:CASTILE
Practice Address - State:NY
Practice Address - Zip Code:14427-0505
Practice Address - Country:US
Practice Address - Phone:585-493-2587
Practice Address - Fax:585-493-5580
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2220207Q00000X
NY0022201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP020177372OtherEXCELLUS BCBS
0102767OtherINDEPENDENT HEALTH
MDH353OtherPREFERRED CARE
000560354003OtherCOMMUNITY BLUE
431989695OtherEMPIRE
00010158803OtherUNIVERA
NYP010177372OtherBLUE CHOICE
NY01139986Medicaid
0102974OtherIPA