Healthcare Provider Details

I. General information

NPI: 1366465189
Provider Name (Legal Business Name): ELIZABETH A TALBOT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR INFECTIOUS DISEASE AND INTERNATIONAL HEALTH SECTION
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DHMC-INFECTIOUS DISEASE & INTERNATIONAL HEALTH SECTION
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-8840
  • Fax: 603-650-1566
Mailing address:
  • Phone: 603-650-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number12211
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: