Healthcare Provider Details

I. General information

NPI: 1235329962
Provider Name (Legal Business Name): ELSA S. LI, M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 MAIN STREET SUITE 101
NORTHBORO MA
01532
US

IV. Provider business mailing address

112 MAIN STREET SUITE 101
NORTHBORO MA
01532
US

V. Phone/Fax

Practice location:
  • Phone: 508-393-7807
  • Fax: 508-393-8608
Mailing address:
  • Phone: 508-393-7807
  • Fax: 508-393-8608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ELSA S LI
Title or Position: OWNER
Credential:
Phone: 508-393-7807