Provider Demographics
NPI:1740500107
Name:KING, ELIZABETH G (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:G
Last Name:KING
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Gender:F
Credentials:MD
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Mailing Address - Street 1:801 ALBANY ST FL G
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-3791
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:732 HARRISON AVE
Practice Address - Street 2:PRESTON, 3RD FL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-8488
Practice Address - Fax:617-638-8469
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2020-11-10
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Provider Licenses
StateLicense IDTaxonomies
MA253680208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110095308AMedicaid