Provider Demographics
NPI:1548365554
Name:DESILLIER, ELENA ADRIANA (MD)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:ADRIANA
Last Name:DESILLIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:77 WARREN ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3601
Mailing Address - Country:US
Mailing Address - Phone:617-562-5485
Mailing Address - Fax:617-562-5415
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:DEPT. ANESTHESIOLOGY & PAIN MEDICINE
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-789-2777
Practice Address - Fax:617-562-5415
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA224058174400000X, 207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No174400000XOther Service ProvidersSpecialist
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2115603Medicaid
MAHX5254Medicare PIN
MA2115603Medicaid