Provider Demographics
NPI:1114974656
Name:DUNN, ELIZABETH ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ROSS
Last Name:DUNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 PILGRIM RD
Mailing Address - Street 2:BIDMC, DEACONESS 1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5324
Mailing Address - Country:US
Mailing Address - Phone:617-632-8416
Mailing Address - Fax:
Practice Address - Street 1:185 PILGRIM RD
Practice Address - Street 2:BIDMC, DEACONESS 1
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5324
Practice Address - Country:US
Practice Address - Phone:617-632-8416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1573442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3205088Medicaid
MAA29716Medicare ID - Type Unspecified
MA3205088Medicaid