Individual
ELIZABETH PRUSAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
41 MALL RD, BURLINGTON, MA 01805-0001
(781) 744-5100
Mailing address
3403 E RAYMOND ST, INDIANAPOLIS, IN 46203-4744
(317) 957-2000
(317) 957-2050
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01083083A
IN
207VG0400X
Gynecology Physician
242943
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110086089A
—
MA
Enumeration date
12/12/2007
Last updated
01/16/2020
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