Provider Demographics
NPI:1023011236
Name:ADDERSON, ELISABETH E (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:E
Last Name:ADDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:262 DANNY THOMAS PLACE., MS 0515
Mailing Address - Street 2:ST. JUDE CHILDREN'S RESEARCH HOSPITAL
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3678
Mailing Address - Country:US
Mailing Address - Phone:901-595-3006
Mailing Address - Fax:901-595-3842
Practice Address - Street 1:262 DANNY THOMAS PLACE., MS 0515
Practice Address - Street 2:ST. JUDE CHILDREN'S RESEARCH HOSPITAL
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105
Practice Address - Country:US
Practice Address - Phone:901-595-3006
Practice Address - Fax:901-595-3842
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN318122080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100179830AMedicaid
KS200379130AMedicaid
MS00121227Medicaid
AR138461001Medicaid
LA1561843Medicaid
ME422400000Medicaid
MO205026305Medicaid
TN3897997Medicaid
KY64008287Medicaid
MI104788392Medicaid
IA0527788Medicaid
WY1146360 00Medicaid
IN200253180AMedicaid
WY1146360 00Medicaid