Henricks, Elise Marie

Henricks, Elise Marie is an individual health care provider with primary practice located at 415 Columbia Rd , Dorchester MA 02125-2424. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Henricks, Elise Marie can be contacted via phone (617) 740-8075.

Contact Information

Primary practice address
415 Columbia Rd Dorchester MA 02125-2424
Phone: (617) 740-8075
Fax: (617) 740-8060
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 156706 Massachusetts

Profile Details

NPI number 1154392850
LBN Legal business name Henricks, Elise Marie
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 30th, 2006
Last updated Jan 9th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154392850 NPPES
Other 710514BMC HARVARD PILGRIM
Other J19583 HARVARD PILGRIM
Other 44447 HARVARD PILGRIM
Other 156706 HARVARD PILGRIM
MEDICAID 3184846 HARVARD PILGRIM

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