Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 15375 | NH |
N | 111NI0900X | Internist | 15375 | NH |
N | 207R00000X | Internist | 48658 | MN |
N | 111NI0900X | Internist | 48658 | MN |
Y | 207RA0201X | Internist - Allergy & Immunology | 15375 | NH |
N | 207RA0201X | Internist - Allergy & Immunology | 48658 | MN |
NPI | 1427062405 |
---|---|
Provider Name | Martha K Elias |
First Address | Lebanon, NH 03756-1000 |
Second Address | Lebanon, NH 03756-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 28/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1019915 | (05) | VT |
3079128 | (05) | NH |
35273000 | (05) | WI |
443930000 | (05) | MN |
I56108 | (02) | |
P00349538 | RAILROAD MEDICARE (01) | MN |