Provider Demographics
NPI:1619991064
Name:FARNUM, ELISABETH K (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:K
Last Name:FARNUM
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 1:215 TALL GATE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-736-4570
Mailing Address - Fax:401-681-4980
Practice Address - Street 1:215 TALL GATE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-736-4570
Practice Address - Fax:401-681-4980
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301108765207Q00000X
DEC1-0011547207Q00000X
NJ25MA09833800207Q00000X
MA265343207Q00000X
MDD80704207Q00000X
MEMD20824207Q00000X
PAMD456976207Q00000X
CT55110207Q00000X
IN01076690A207Q00000X
VT042.0013369207Q00000X
FLME130791207Q00000X
GA077731207Q00000X
NY282381207Q00000X
RIMD08497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
203459OtherBLUECHIP
404222OtherTUFTS
713736OtherHARVARD PILGRIM
RIEF01846Medicaid
NONHMO5270203OtherAETNA US HEALTHCARE
RI1671OtherNEIGHBORHOOD HEALTH
HMO2287823OtherAETNA US HEALTHCARE
0101201OtherUNITED HEALTHCARE
RI229977OtherBCBS
RI1671OtherNEIGHBORHOOD HEALTH
RIEF01846Medicaid