Provider Demographics
NPI:1356635916
Name:ALT, ELIZABETH N (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:N
Last Name:ALT
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 1:100 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER BY THE SEA
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1139
Mailing Address - Country:US
Mailing Address - Phone:617-947-5785
Mailing Address - Fax:
Practice Address - Street 1:250 PARADISE RD
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-2948
Practice Address - Country:US
Practice Address - Phone:781-586-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2455532083P0901X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine