Healthcare Provider Details

I. General information

NPI: 1295097251
Provider Name (Legal Business Name): ELINOR M MILDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 MAIN ST SUITE 100
MEDFORD MA
02155
US

IV. Provider business mailing address

137 MAIN ST SUITE 100
MEDFORD MA
02155
US

V. Phone/Fax

Practice location:
  • Phone: 781-395-4761
  • Fax: 781-395-5081
Mailing address:
  • Phone: 781-395-4761
  • Fax: 781-395-5081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number264841
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: