Provider Demographics
NPI:1922083542
Name:KAPLAN, ELISSA EHRLICH (MD)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:EHRLICH
Last Name:KAPLAN
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 1:2000 WASHINGTON ST
Mailing Address - Street 2:SUITE 368
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1650
Mailing Address - Country:US
Mailing Address - Phone:617-969-1227
Mailing Address - Fax:617-969-2676
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:SUITE 368
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1650
Practice Address - Country:US
Practice Address - Phone:617-969-1227
Practice Address - Fax:617-969-2676
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214021207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2109131Medicaid
H95239Medicare UPIN
A36109Medicare ID - Type Unspecified