Provider Demographics
NPI:1508037763
Name:POULTER, ELANA Y (MD)
Entity Type:Individual
Prefix:
First Name:ELANA
Middle Name:Y
Last Name:POULTER
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 1:477 ANDOVER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5036
Mailing Address - Country:US
Mailing Address - Phone:978-975-3355
Mailing Address - Fax:
Practice Address - Street 1:477 ANDOVER ST
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5036
Practice Address - Country:US
Practice Address - Phone:978-975-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119638208000000X
MA245266208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics