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General NPI Number Information
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NPI Number | 1831355973
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Entity Type | Individual
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Provider Name | DIANE ELOFSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 48 FRONT ST
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City | LINCOLN
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State | RI
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Zip | 02865-1700
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Country | US
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Telephone | 401-749-2242
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Fax |
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Provider Business Mailing Address
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Address Line | 7 BLUE MIST DR
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City | MANVILLE
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State | RI
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Zip | 02838-1002
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Country | US
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Telephone | 401-658-4963
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD07444
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License Number State | RI
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