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Provider Information for 1114942190

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. SCOTT A ELISOFON MD

Gender: MALE

Individual NPI: 1114942190

Calendar   Last Updated:  2015-08-24
  Certification Date: 

Details

Name Value
NPI 1114942190
Enumeration Date 2006-07-12
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 300 LONGWOOD AVE HUNNEWELL GROUND, DIVISION OF GASTROENTEROLOGY
BOSTON, MA 02115-5724
United States

Phone: 617-355-7964 | Fax:
View Map External Link
Primary Practice Address 300 LONGWOOD AVE HUNNEWELL GROUND, DIVISION OF GASTROENTEROLOGY
BOSTON, MA 02115-5724
United States

Phone: 617-355-7964 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 2080T0004X - Pediatrics Pediatric Transplant Hepatology MA 213587
No 2080P0206X - Pediatrics Pediatric Gastroenterology MA 213587