Provider Demographics
NPI:1689647026
Name:DOOLING, ELIZABETH CLARK (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CLARK
Last Name:DOOLING
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:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-3877
Mailing Address - Fax:617-724-7860
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:WANG ACC 720
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-3877
Practice Address - Fax:617-724-7860
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA29710208000000X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110002667/BMedicaid
MAM08166OtherBCBS MA
MA11034MGHOtherHARVARD PILGRIM HEALTHCARE
MA700930OtherTUFTS HEALTH PLAN
MAM08166Medicare ID - Type Unspecified
MA110002667/BMedicaid