Provider Demographics
NPI:1861592404
Name:MATZKIN, ELIZABETH G (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:G
Last Name:MATZKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:BWH DEPARTMENT OF ORTHOPEDIC SURGERY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-525-8500
Mailing Address - Fax:617-264-5232
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:BWH DEPARTMENT OF ORTHOPEDIC SURGERY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-525-8500
Practice Address - Fax:617-264-5232
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11586207X00000X, 207XX0005X
MA230751207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI411918OtherBLUE CHIP
RI27825OtherBLUE CROSS
RI007056977Medicare ID - Type Unspecified
RIH91594Medicare UPIN