Provider Demographics
NPI:1831355973
Name:ELOFSON, DIANE (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:ELOFSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BLUE MIST DR
Mailing Address - Street 2:
Mailing Address - City:MANVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02838-1002
Mailing Address - Country:US
Mailing Address - Phone:401-658-4963
Mailing Address - Fax:
Practice Address - Street 1:48 FRONT ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1700
Practice Address - Country:US
Practice Address - Phone:401-749-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07444208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics