Healthcare Provider Details

I. General information

NPI: 1114138765
Provider Name (Legal Business Name): ELIZABETH TAN ROSOLOWSKY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LONGWOOD AVE SUITE 618
BOSTON MA
02115-5711
US

IV. Provider business mailing address

404 MOUNT AUBURN ST
WATERTOWN MA
02472-1968
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-2185
  • Fax: 617-730-0194
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number224232
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number224232
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: