MEDICARE: DR. ELISABETH M.C. COUSENS 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	207Q00000X	Family Medicine Physician	MD058915L	PA

General Provider Information

NPI Number	:	1922003433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELISABETH M.C. COUSENS MD

Provider Business Mailing Address
First Line	:	1380 EASTON RD
Second Line	:
City	:	WARRINGTON
State	:	PA
Zip	:	18976-1818
Country	:	US
Telephone Number	:	215-491-5063
Fax Number	:	215-491-5066

Provider Business Practice Location Address
First Line	:	1380 EASTON RD
Second Line	:
City	:	WARRINGTON
State	:	PA
Zip	:	18976-1818
Country	:	US
Telephone Number	:	215-491-5063
Fax Number	:	215-491-5066

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	11/10/2008

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