Provider Demographics
NPI:1346312113
Name:PIETRAS, ELIZABETH S (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:PIETRAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:SHEEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:324 GANNETT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3266
Mailing Address - Country:US
Mailing Address - Phone:207-482-7800
Mailing Address - Fax:
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3134
Practice Address - Country:US
Practice Address - Phone:207-662-2571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD145142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEM108751OtherCIGNA
NHRE7134Medicare ID - Type Unspecified
ME26002099Medicaid
NH01Y003975NH01OtherANTHEM
ME2323484OtherAETNA USHC
ME030161OtherANTHEM
MEMM6895Medicare ID - Type Unspecified
MM689501Medicare PIN
MEG28520Medicare UPIN
ME0005115171OtherAETNA
MEMNT987OtherHPHC
ME300075524Medicare ID - Type UnspecifiedRAILROAD
NH30010583Medicaid