Provider Demographics
NPI:1962482190
Name:VINTON, ELIZABETH C (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:VINTON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8374
Mailing Address - Fax:
Practice Address - Street 1:1611 CAMBRIDGE ST
Practice Address - Street 2:PEDIATRICS DEPT
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4302
Practice Address - Country:US
Practice Address - Phone:617-661-5575
Practice Address - Fax:617-661-5134
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2012-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA59797208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0015160OtherNEIGHBORHOOD HEALTH
MA059797OtherTUFTS
MAJ08188OtherBLUE CROSS
MAPP508OtherHARVARD PILGRIM
MA3049434Medicaid
MA3049434Medicaid
MAPP508OtherHARVARD PILGRIM