Healthcare Provider Details

I. General information

NPI: 1801145735
Provider Name (Legal Business Name): ELIZABETH MERRIAM SHOR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WATER ST SUITE 1-A
ARLINGTON MA
02476-4812
US

IV. Provider business mailing address

9850 GENESEE AVE 320
LA JOLLA CA
92037-1208
US

V. Phone/Fax

Practice location:
  • Phone: 781-648-9700
  • Fax:
Mailing address:
  • Phone: 858-554-1212
  • Fax: 858-554-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA4533
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: