Provider Demographics
NPI:1164467866
Name:RAMBO, ELISA M (M D)
Entity Type:Individual
Prefix:DR
First Name:ELISA
Middle Name:M
Last Name:RAMBO
Suffix:
Gender:F
Credentials:M D
Other - Prefix:DR
Other - First Name:ELISA
Other - Middle Name:M
Other - Last Name:LUTZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:680 E MAIN ST # 599
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-2113
Mailing Address - Country:US
Mailing Address - Phone:480-347-2570
Mailing Address - Fax:480-865-2329
Practice Address - Street 1:680 E MAIN ST # 599
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-2113
Practice Address - Country:US
Practice Address - Phone:480-347-2570
Practice Address - Fax:480-865-2329
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA942032084P0800X
CT0425922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT042592OtherCONNECTICUT LICENSE NUMBER
CAA94203OtherCALIFORNIA LICENSE NUMBER
CAA94203OtherCALIFORNIA LICENSE NUMBER