Provider Demographics
NPI:1346221330
Name:BROWN, ELIZABETH R (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DIVISION OF PEDIATRICS DOWLING 3 SOUTH
Mailing Address - Street 2:ONE BOSTON MEDICAL CENTER PLACE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-414-5170
Mailing Address - Fax:617-414-3803
Practice Address - Street 1:CHILD HEALTH FOUNDATION OF BOSTON
Practice Address - Street 2:DOWLING 3 SOUTH ONE BOSTON MEDICAL CENTER PLACE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-414-2170
Practice Address - Fax:617-414-3803
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA39312208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2053349Medicaid
MA2053349Medicaid