Provider Demographics
NPI:1649359704
Name:CONKLIN, ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:CONKLIN
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 1:70 FRANKS NECK RD
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-4602
Mailing Address - Country:US
Mailing Address - Phone:401-783-3893
Mailing Address - Fax:401-789-1358
Practice Address - Street 1:70 KENYON AVE
Practice Address - Street 2:STE 325
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4239
Practice Address - Country:US
Practice Address - Phone:401-284-4114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD09281174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist