Provider Demographics
NPI:1689605933
Name:PERKINS, ELISSA MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:MICHELLE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELISSA
Other - Middle Name:MICHELLE
Other - Last Name:SCHECHTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:960 MASSACHUSETTS AVENUE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 BOSTON MEDICAL CTR PL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2908
Practice Address - Country:US
Practice Address - Phone:617-414-5481
Practice Address - Fax:617-414-7757
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235880207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3120997Medicaid
MA110080677AMedicaid