Provider Demographics
NPI:1013929389
Name:MCLEISH, ELIZABETH JEAN (PA C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JEAN
Last Name:MCLEISH
Suffix:
Gender:F
Credentials:PA C
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Mailing Address - Street 1:1 SCOBEE CIR
Mailing Address - Street 2:STE 3
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4887
Mailing Address - Country:US
Mailing Address - Phone:508-747-0711
Mailing Address - Fax:508-747-0011
Practice Address - Street 1:45 RESNIK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360
Practice Address - Country:US
Practice Address - Phone:508-747-0711
Practice Address - Fax:508-746-9265
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2016-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA873363A00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
S91948Medicare UPIN
MAAP1134Medicare ID - Type Unspecified