1043639503 NPI number — ELISABETH THAMES BOEHME ASKIN M.D.

Table of content: ELISABETH THAMES BOEHME ASKIN M.D. (NPI 1043639503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043639503 NPI number — ELISABETH THAMES BOEHME ASKIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASKIN
Provider First Name:
ELISABETH
Provider Middle Name:
THAMES BOEHME
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOEHME
Provider Other First Name:
ELISABETH
Provider Other Middle Name:
THAMES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043639503
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1545 DIVISADERO ST
Provider Second Line Business Mailing Address:
SUITE 322
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94143-3425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-435-8580
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1545 DIVISADERO ST
Provider Second Line Business Practice Location Address:
SUITE 322
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94143-3425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-435-8580
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A141891 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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