Provider Demographics
NPI:1861620411
Name:BROWNSON, ELISHA GLORY (MD)
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:GLORY
Last Name:BROWNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELISHA
Other - Middle Name:GLORY
Other - Last Name:GIONET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:88 E NEWTON ST
Mailing Address - Street 2:C515
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2308
Mailing Address - Country:US
Mailing Address - Phone:617-638-8409
Mailing Address - Fax:
Practice Address - Street 1:88 E NEWTON ST
Practice Address - Street 2:C515
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2308
Practice Address - Country:US
Practice Address - Phone:617-638-8409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241724208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery