Provider Demographics
NPI:1235242215
Name:BURBANK, ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:BURBANK
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 1:25 TUCKER DR
Mailing Address - Street 2:HEALTHALLIANCE HOME HEALTH & HOSPICE
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453
Mailing Address - Country:US
Mailing Address - Phone:978-728-0621
Mailing Address - Fax:978-728-0656
Practice Address - Street 1:25 TUCKER DR
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-6501
Practice Address - Country:US
Practice Address - Phone:978-728-0621
Practice Address - Fax:978-728-0656
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA150812207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA71791OtherHARVARD PILGRIM HEALTH
MAJ18126OtherBLUE CROSS & BLUE SHIELD
MA3170055Medicaid
MA7436OtherFALLON HEALTH CARE
MA986235OtherNETWORK HEALTH
1039249OtherAETNA US HEALTH
MA150812OtherTUFTS
MA150812OtherTUFTS
MA71791OtherHARVARD PILGRIM HEALTH