Provider Demographics
NPI:1003161589
Name:ST. ELIZABETH MEDICAL CENTER
Entity Type:Organization
Organization Name:ST. ELIZABETH MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUGICAL EDUCATION COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:VINCENZA
Authorized Official - Middle Name:
Authorized Official - Last Name:GELARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-789-2990
Mailing Address - Street 1:172 SUMMER ST APT 8
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-5647
Mailing Address - Country:US
Mailing Address - Phone:617-595-3797
Mailing Address - Fax:
Practice Address - Street 1:172 SUMMER ST APT 8
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-5647
Practice Address - Country:US
Practice Address - Phone:617-595-3797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT253000282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access