MEDICARE: DR. ELIZABETH ELIACIN 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
1	207R00000X	Internal Medicine Physician	055125	GA

General Provider Information

NPI Number	:	1215918461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH ELIACIN MD

Provider Business Mailing Address
First Line	:	24 HOSPITAL LN
Second Line	:
City	:	CALAIS
State	:	ME
Zip	:	04619-1329
Country	:	US
Telephone Number	:	207-454-9300
Fax Number	:	207-454-9238

Provider Business Practice Location Address
First Line	:	24 HOSPITAL LN
Second Line	:
City	:	CALAIS
State	:	ME
Zip	:	04619-1329
Country	:	US
Telephone Number	:	207-454-9300
Fax Number	:	207-454-9238

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	07/21/2022

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