Provider Demographics
NPI:1023123791
Name:ELDRIDGE, ANN L (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:L
Last Name:ELDRIDGE
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 1:60 MUNSON MEETING WAY STE K
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02633-1992
Mailing Address - Country:US
Mailing Address - Phone:508-945-0022
Mailing Address - Fax:
Practice Address - Street 1:60 MUNSON MEETING WAY STE K
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:MA
Practice Address - Zip Code:02633-1992
Practice Address - Country:US
Practice Address - Phone:508-945-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76776207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3116352Medicaid
MAJ13466OtherBC/BS
MAJ13466Medicare PIN
MA3116352Medicaid