Provider Demographics
NPI:1770724296
Name:FERRENZ, ELIZABETH EIDEANN (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:EIDEANN
Last Name:FERRENZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:771 ALBANY ST
Mailing Address - Street 2:DOWLING 5 SOUTH
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2525
Mailing Address - Country:US
Mailing Address - Phone:617-414-6235
Mailing Address - Fax:617-414-3345
Practice Address - Street 1:850 HARRISON AVE
Practice Address - Street 2:YAWKEY ACC 3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4001
Practice Address - Country:US
Practice Address - Phone:617-414-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA249335207Q00000X
CAA106849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA002392501Medicare PIN