Healthcare Provider Details

I. General information

NPI: 1174514855
Provider Name (Legal Business Name): ELIZABETH B CARONNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE BOSTON MEDICAL CENTER PLACE CHILD HEALTH FOUNDATION OF BOSTON DOWLING 3 SOUTH
BOSTON MA
02118
US

IV. Provider business mailing address

ONE BOSTON MEDICAL CENTER PLACE DIVISION OF PEDIATRICS DOWLING 3 SOUTH
BOSTON MA
02118
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-5170
  • Fax: 617-414-3803
Mailing address:
  • Phone: 617-414-5170
  • Fax: 617-414-3803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number205381
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number205381
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: