Provider Demographics
NPI:1376799049
Name:FORTESCUE, ELIZABETH BOWEN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:BOWEN
Last Name:FORTESCUE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:BOWEN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:FARLEY 174
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-899-6553
Mailing Address - Fax:781-237-4833
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:FARLEY 174
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-899-6553
Practice Address - Fax:781-237-4833
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2377081744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study