Provider Demographics
NPI:1083720858
Name:SOUKUP, ELIZABETH SAILHAMER (MD, MMSC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SAILHAMER
Last Name:SOUKUP
Suffix:
Gender:F
Credentials:MD, MMSC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1 ELLIOT WAY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3502
Mailing Address - Country:US
Mailing Address - Phone:603-663-8393
Mailing Address - Fax:603-663-3493
Practice Address - Street 1:1 ELLIOT WAY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3502
Practice Address - Country:US
Practice Address - Phone:603-663-8393
Practice Address - Fax:603-663-3493
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH163912086S0120X
UT8303597-12052086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery