Basic Information
| Provider Information | |||||||||
| NPI: | 1760506299 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OH | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | KELLY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 147 MILK ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021094806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175598239 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1250 HANCOCK ST | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021694339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177740660 | ||||||||
| FaxNumber: | 6177740666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 02/24/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 240919 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 4301084005 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics | 390200000X | 4301084005 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.