Provider Demographics
NPI:1841248804
Name:CONNELLY, ELIZABETH F (DO)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:F
Last Name:CONNELLY
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MILES CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4067
Mailing Address - Country:US
Mailing Address - Phone:207-563-4046
Mailing Address - Fax:207-810-4994
Practice Address - Street 1:24 MILES CENTER WAY
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4067
Practice Address - Country:US
Practice Address - Phone:207-563-4046
Practice Address - Fax:207-810-4994
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME34136207RH0003X
HIDOS-2523207RH0003X
MEDO1975207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP00458864OtherRAILROAD MEDICARE
MEVX2724Medicare PIN
OHA80347Medicare UPIN
OHCOO512702Medicare ID - Type Unspecified
MEA80347Medicare UPIN