Provider Demographics
NPI:1700874039
Name:PEPE, ELIZABETH M (DO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:PEPE
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:9 GALEN ST STE 240
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4522
Mailing Address - Country:US
Mailing Address - Phone:857-268-3190
Mailing Address - Fax:617-562-5289
Practice Address - Street 1:206 E NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4504
Practice Address - Country:US
Practice Address - Phone:321-802-3311
Practice Address - Fax:321-802-5324
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2023-09-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS 0005398207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
593671762OtherCHAMPUS TRICARE
80187OtherBLUE SHIELD
80187OtherBLUE SHIELD
FL80187TMedicare ID - Type Unspecified