Provider Demographics
NPI:1346394418
Name:MEDAGLIA, ELIZABETH E (LIC AC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:MEDAGLIA
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WATER ST
Mailing Address - Street 2:#3
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-2241
Mailing Address - Country:US
Mailing Address - Phone:617-869-6371
Mailing Address - Fax:
Practice Address - Street 1:57 WATER ST
Practice Address - Street 2:#3
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-2241
Practice Address - Country:US
Practice Address - Phone:617-869-6371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218439171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist