Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 873 | MA |
NPI | 1013929389 |
---|---|
Provider Name | Elizabeth Jean Mcleish |
First Address | Plymouth, MA 02360-4887 |
Second Address | Plymouth, MA 02360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 29/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S91948 | (02) |