Healthcare Provider Details

I. General information

NPI: 1760463954
Provider Name (Legal Business Name): ELIZABETH ANNE TURNOCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 HANOVER ST NORTH END COMMUNITY HEALTH CENTER NHC
BOSTON MA
02113-1901
US

IV. Provider business mailing address

PO BOX 9142 MASS GENERAL PHYSICIAN ORGANIZATION
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-8000
  • Fax: 617-643-8122
Mailing address:
  • Phone: 617-643-8041
  • Fax: 617-726-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number80386
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: