Provider Demographics
NPI:1659799161
Name:OTMASKIN, ELIZABETH A (DO)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:OTMASKIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3455 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1187
Mailing Address - Country:US
Mailing Address - Phone:413-794-8484
Mailing Address - Fax:413-479-4184
Practice Address - Street 1:3455 MAIN STREET SUITE C
Practice Address - Street 2:BAYSTTATE OB GYN GROUP INC
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107
Practice Address - Country:US
Practice Address - Phone:413-794-8484
Practice Address - Fax:413-794-8477
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA274604207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology