Provider Demographics
NPI:1912066739
Name:BELLOWS, ELISABETH PROSSER (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:PROSSER
Last Name:BELLOWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:617 VETERANS BLVD.
Mailing Address - Street 2:SUITE #107
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063
Mailing Address - Country:US
Mailing Address - Phone:650-306-8909
Mailing Address - Fax:650-306-8910
Practice Address - Street 1:617 VETERANS BLVD.
Practice Address - Street 2:SUITE #107
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063
Practice Address - Country:US
Practice Address - Phone:650-306-8909
Practice Address - Fax:650-306-8910
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG500672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG50067OtherLICENSE NUMBER
CAF47900Medicare PIN
CAG50067OtherLICENSE NUMBER