Provider Demographics
NPI:1568408383
Name:O'BRIEN, ELIZABETH SOANES (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SOANES
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3 SAREDON PLACE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606
Mailing Address - Country:US
Mailing Address - Phone:585-225-0950
Mailing Address - Fax:585-225-9093
Practice Address - Street 1:3 SAREDON PLACE
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606
Practice Address - Country:US
Practice Address - Phone:585-225-0950
Practice Address - Fax:585-225-9093
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY209094208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G68408Medicare UPIN