Provider Demographics
NPI:1518043652
Name:BOHAM, ELIZABETH W (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:W
Last Name:BOHAM
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 1:55 PITTSFIELD RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:01240-2123
Mailing Address - Country:US
Mailing Address - Phone:413-637-9991
Mailing Address - Fax:
Practice Address - Street 1:55 PITTSFIELD RD
Practice Address - Street 2:SUITE 9
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2123
Practice Address - Country:US
Practice Address - Phone:413-637-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine