Provider Demographics
NPI:1902893860
Name:BRITTON, ELISABETH M (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:M
Last Name:BRITTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:WI
Mailing Address - Zip Code:53039-1165
Mailing Address - Country:US
Mailing Address - Phone:920-386-8101
Mailing Address - Fax:920-386-8109
Practice Address - Street 1:701 SENECA ST STE 646C
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210-1351
Practice Address - Country:US
Practice Address - Phone:716-995-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016608207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME416210099Medicaid
ME010460405OtherINDIVIDUAL BILLING NUMBER
WI1902893860Medicaid
MEI21658Medicare UPIN
MEME1048Medicare ID - Type UnspecifiedINDIVIDUAL BILLING NUMBER