Provider Demographics
NPI:1396728606
Name:RECUPERO, ELIZABETH ANN (DO)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:RECUPERO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:103 CONCORDE PL
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-1854
Mailing Address - Country:US
Mailing Address - Phone:619-648-1247
Mailing Address - Fax:888-354-0043
Practice Address - Street 1:103 CONCORDE PL
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-1854
Practice Address - Country:US
Practice Address - Phone:619-648-1247
Practice Address - Fax:888-354-0043
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA311932207R00000X
NJMB67859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3110885OtherAETNA HMO PEDIATRICS
PARE1437759OtherPA BLUE SHIELD
NJF06020OtherPHS
NJ2996178OtherAETNA HMO (ADULTS)
NJ4685447OtherAETNA TRADITIONAL
NJ2144789001OtherAMERIHEALTH
NJ7685447OtherAETNA TRADITIONAL ADULTS
NJP2216217OtherOXFORD
NJP2216217OtherOXFORD
NJ2996178OtherAETNA HMO (ADULTS)