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NPI Code Detail

MEDICARE: DR. ELIZABETH PARKS PROUT MD

MEDICARE: DR. ELIZABETH PARKS PROUT MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician213338MA
22080P0206XPediatric Gastroenterology PhysicianMD431891PA

General Provider Information

NPI Number : 1205817327
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIZABETH PARKS PROUT MD
Provider Business Mailing Address
First Line : 100 E PENN SQ
Second Line : 9TH FLOOR
City : PHILADELPHIA
State : PA
Zip : 19107-3323
Country : US
Telephone Number : 267-425-9258
Fax Number : 267-425-9299
Provider Business Practice Location Address
First Line : 3401 CIVIC CENTER BLVD
Second Line : CHILDREN'S HOSPITAL OF PHILA - GASTRO & NUTRITION
City : PHILADELPHIA
State : PA
Zip : 19104-4319
Country : US
Telephone Number : 215-590-3247
Fax Number : 215-590-3606
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2005
Last Update Date : 11/24/2014

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Directions to “ DR. ELIZABETH PARKS PROUT MD” Practice Location

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