Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 231486 | MA |
Y | 2084N0402X | Child Neurologist | 231486 | MA |
NPI | 1063614352 |
---|---|
Provider Name | Dr. Elizabeth Ann Barkoudah |
First Address | Jamaica Plain, MA 02130-2515 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 14/04/2014 |