Healthcare Provider Details

I. General information

NPI: 1427251149
Provider Name (Legal Business Name): ELENA GORLOVSKY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 RICHARDSON AVE
WAKEFIELD MA
01880-2917
US

IV. Provider business mailing address

15 RICHARDSON AVE
WAKEFIELD MA
01880-2917
US

V. Phone/Fax

Practice location:
  • Phone: 781-245-2203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number153242
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ELENA GORLOVSKY
Title or Position: MD
Credential: M.D.
Phone: 781-245-2203