Provider Demographics
NPI:1730616483
Name:VAN DELDEN, ELKE (RMT)
Entity type:Individual
Prefix:
First Name:ELKE
Middle Name:
Last Name:VAN DELDEN
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7332 PICNIC WOODS RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-7111
Mailing Address - Country:US
Mailing Address - Phone:301-992-8623
Mailing Address - Fax:
Practice Address - Street 1:7332 PICNIC WOODS RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:MD
Practice Address - Zip Code:21769-7111
Practice Address - Country:US
Practice Address - Phone:301-992-8623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM35323225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist