Provider Demographics
NPI:1023300670
Name:GENNIS, ELISABETH ROSL (MD)
Entity type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:ROSL
Last Name:GENNIS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:14 RESEARCH PL
Mailing Address - Street 2:
Mailing Address - City:N CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-2412
Mailing Address - Country:US
Mailing Address - Phone:978-454-2715
Mailing Address - Fax:978-259-4697
Practice Address - Street 1:14 RESEARCH PL
Practice Address - Street 2:
Practice Address - City:N CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2412
Practice Address - Country:US
Practice Address - Phone:978-454-2715
Practice Address - Fax:978-259-4697
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2018-03-17
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Provider Licenses
StateLicense IDTaxonomies
MA270444207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1023300670OtherNPI