Provider Demographics
NPI:1740286749
Name:BOSSINGHAM, ELISABETH A (MD)
Entity type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:A
Last Name:BOSSINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ELISABETH
Other - Middle Name:A
Other - Last Name:HOAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1827 S COURT ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-5469
Mailing Address - Country:US
Mailing Address - Phone:559-622-0800
Mailing Address - Fax:559-622-0801
Practice Address - Street 1:1827 S COURT ST
Practice Address - Street 2:SUITE F
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-5469
Practice Address - Country:US
Practice Address - Phone:559-622-0800
Practice Address - Fax:559-622-0801
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69388208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
BH2464965OtherDEA
BH2464965OtherDEA