1366436974 NPI number — MS. ELIZABETH OBBER BETTENCOURT MD

Table of content: MS. ELIZABETH OBBER BETTENCOURT MD (NPI 1366436974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366436974 NPI number — MS. ELIZABETH OBBER BETTENCOURT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BETTENCOURT
Provider First Name:
ELIZABETH
Provider Middle Name:
OBBER
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366436974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 ROWE STREET
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
MELROSE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-665-6606
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 ROWE ST
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
MELROSE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02176-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-665-6606
Provider Business Practice Location Address Fax Number:
781-665-1277
Provider Enumeration Date:
09/09/2005

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: 207V00000X , with the licence number:  207705 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0167291 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com