MEDICARE: DR. EDWARD F. ELLIOTT JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	01029450	IN
2	2085R0202X	Diagnostic Radiology Physician	0420008401	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013953793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD F. ELLIOTT JR. M.D.

Provider Business Mailing Address
First Line	:	88 HIGH ST
Second Line	:
City	:	BRATTLEBORO
State	:	VT
Zip	:	05301-6074
Country	:	US
Telephone Number	:	802-257-7513
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 BELMONT AVE
Second Line	:
City	:	BRATTLEBORO
State	:	VT
Zip	:	05301-6613
Country	:	US
Telephone Number	:	802-257-8820
Fax Number	:	802-257-8849

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. EDWARD F. ELLIOTT JR. M.D.” Practice Location

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