Provider Demographics
NPI:1801145735
Name:SHOR, ELIZABETH MERRIAM (PA-C)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MERRIAM
Last Name:SHOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9850 GENESEE AVE 320
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1208
Mailing Address - Country:US
Mailing Address - Phone:858-554-1212
Mailing Address - Fax:858-554-1222
Practice Address - Street 1:11 WATER ST
Practice Address - Street 2:SUITE 1-A
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4812
Practice Address - Country:US
Practice Address - Phone:781-648-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program