Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | ME0070262 | FL |
NPI | 1417277831 |
---|---|
Provider Name | Dr. Mary Catherine Elliott |
First Address | Melbourne, FL 32904-9517 |
Second Address | Melbourne, FL 32904-9517 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2010 |
Last Update Date | 08/06/2010 |