Provider Demographics
NPI:1831197441
Name:HOWARD, ELIZABETH A (DO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:HOWARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:EDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1301 RIVER ST RM 101
Mailing Address - Street 2:VALATIE MEDICAL ARTS BLDG
Mailing Address - City:VALATIE
Mailing Address - State:NY
Mailing Address - Zip Code:12184-9696
Mailing Address - Country:US
Mailing Address - Phone:518-758-6101
Mailing Address - Fax:518-758-2162
Practice Address - Street 1:1301 RIVER ST RM 101
Practice Address - Street 2:VALATIE MEDICAL ARTS BLDG
Practice Address - City:VALATIE
Practice Address - State:NY
Practice Address - Zip Code:12184-9696
Practice Address - Country:US
Practice Address - Phone:518-758-6101
Practice Address - Fax:518-758-2162
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189992-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01937677Medicaid
NY01937677Medicaid
NY067AE1Medicare ID - Type Unspecified