Healthcare Provider Details

I. General information

NPI: 1992743165
Provider Name (Legal Business Name): ELIZABETH ANN FORBES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

1011 VETERANS MEMORIAL PKWY
RIVERSIDE RI
02915-5061
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-6200
  • Fax:
Mailing address:
  • Phone: 401-432-1000
  • Fax: 401-432-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number042.0013989
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: