Provider Demographics
NPI:1982667432
Name:HENSKE, ELIZABETH P (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:P
Last Name:HENSKE
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 1:44 BINNEY STREET
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-355-9049
Mailing Address - Fax:
Practice Address - Street 1:44 BINNEY STREET
Practice Address - Street 2:BRIGHAM AND WOMEN'S HOSP
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-632-5320
Practice Address - Fax:215-214-1023
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72582207RP1001X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA067812Medicare ID - Type Unspecified
PAG43228Medicare UPIN