Individual
DR. ELISE MARIE HENRICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
415 COLUMBIA RD, DORCHESTER, MA 02125-2424
(617) 740-8075
(617) 740-8060
Mailing address
415 COLUMBIA RD, DORCHESTER, MA 02125-2424
(617) 740-8075
(617) 740-8060
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
156706
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
156706
TUFTS
—
05
—
3184846
—
MA
01
—
44447
AETNA/USHEALTHCARE
—
01
—
710514BMC
HARVARD PILGRIM
—
01
—
J19583
HMO BLUE
—
Enumeration date
01/30/2006
Last updated
01/09/2012
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